Accident and Health Senior Claims Specialist (Provider XS/ESL)

AXIS Capital; Princeton (NJ); On-site; USD 95,000 - 130,000; Full time

Benefits offered by this job

Medical plans

Health and wellness programs

Tuition reimbursement

Paid vacation

Job summary

AXIS Capital in Princeton, NJ is seeking an experienced Senior Claims Specialist to provide expertise in managing various claims within the Accident and Health division. Responsibilities include auditing TPAs, overseeing guidelines for specialty claims, and leading special projects. Candidates should have a background in Accident & Health claims, strong analytical skills, and be proficient with Microsoft Office.

The role offers a competitive salary range of $95,000–$130,000 and a comprehensive benefits package, including health plans and retirement plans.

Qualifications

• Prior special Accident & Health insurance claim management experience.
• Prior experience auditing and reviewing TPAs.
• Knowledge of ERISA and state claim handling requirements.

Responsibilities

• Conduct annual and desk auditing of TPAs.
• Assist in due diligence audit of potential TPAs.
• Monitor oversight procedures for TPAs.

Skills

Accident & Health insurance claim management

Auditing TPAs

Data analysis

Excellent communication skills

Education

Bachelor’s degree or equivalent industry experience

Tools

Microsoft Office Suite

Job description

Accident & Health Senior Claims Specialist

We provide senior claims handling expertise for all product lines of the Accident and Health division, both claims adjudicated in‑house and by third‑party administrators (TPAs). Primary products include employer stop‑loss, leisure travel, accident medical, pet, line of duty, limited medical benefits, critical illness, vision, dental and short‑term disability.

What will you do in this role?

• Annual and desk auditing of TPAs, including preparation and presentation of audit reports and findings.
• Assist in the due diligence audit of potential TPAs and the subsequent onboarding of the TPA.
• Monitor oversight procedures for TPAs.
• Assist in the maintenance of guidelines for processing specialty accident and health insurance claims.
• Review claims exceeding TPA threshold, second‑level appeals, coordinate responses to complaints and attorneys, as well as carrier reviews and benefit clarifications.
• Process larger, more complex claims not administered by TPAs.
• Obtain, collate, and review data from monthly TPA reporting packages for trends and seek out corrective action plans when required.
• Communicate with underwriting, actuarial and product development regarding claim trends.
• Produce and review reports for management.
• Lead special projects with planning time horizons of several months or more.

About You

We encourage you to bring your own experience and expertise to the table; while we have certain qualifications, we are open to discussing how your individual knowledge might help us achieve our goals.

What you need to have

• Prior special Accident & Health insurance claim management experience, including substantial experience with medical claims and cost containment.
• Prior experience auditing and reviewing TPAs.
• Knowledge of ERISA and state claim handling requirements.
• Exposure evaluation and reserving skills.
• Bachelor’s degree or equivalent industry experience.
• Insurance designation preferred.
• Three to five years of Accident & Health claim handling experience.

What we prefer you to have

• Highly proficient in Microsoft Office suite applications (Outlook, Word, Excel, PowerPoint).
• Ability to analyze data and draw conclusions from data.
• Excellent writing, negotiation, communication, and interpersonal skills.
• Demonstrated ability to work in a team, interact well with others, meet deadlines, and successfully perform in a changing work environment.

Role Factors

Preferred candidates will be able to commute to an AXIS office three days a week. Travel several times a year within the US and Canada for on‑site TPA audits.

What we offer

Base salary range $95,000–$130,000, with target incentive compensation based on performance. Eligible for a comprehensive benefits package that includes medical plans for you and your family, health and wellness programs, retirement plans, tuition reimbursement, paid vacation, and more.

We are exempt from FLSA purposes.

All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process.