Senior Claims Specialist - TPA Workers Comp

AXA XL; Los Angeles (CA); On-site; USD 104,000 - 182,000; Full time

Job summary

AXA XL is seeking a Senior Claims Specialist for TPA Workers Comp to manage high-value claims across the U.S. The role involves collaboration with various stakeholders to ensure optimal claim outcomes, requiring advanced claim handling experience and strong communication skills.

Benefits

Competitive compensation

Flexible working

Family benefits

Recognition for inclusive culture

Qualifications

• Advanced level claim handling experience involving high value/complex claim management.
• Defined expertise in managing catastrophic workers’ compensation claims.
• Multi-jurisdictional (U.S.) experience.

Responsibilities

• Direct high-value workers’ compensation claims for assigned clients.
• Coordinate coverage referrals and compliance with Third Party Administrators.
• Provide oversight and guidance to TPA claim adjusters.

Skills

Claim handling experience

Litigation management

Excellent communication skills

Negotiation skills

Organizational skills

Strategic thinking

Teamwork and collaboration

Job description

Senior Claims Specialist - TPA Workers Comp

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Job Description

Our Claims team sets us apart. Our experienced Claims professionals use their specialized expertise to handle even the most complex claims seamlessly. How do you make a good thing better? You focus on excellence and creating a culture of continuous improvement. You create an environment that fosters collaboration, customer service, and colleague development. You build a team of passionate and innovative claims experts who see success as a reason to roll up their sleeves and drive for improvement.

What you’ll be doing

What will your essential responsibilities include?

1. Active direction of high-value workers’ compensation claims venue throughout the United States for assigned clients in our US Risk Management, Construction Primary Casualty, or other supported underwriting teams.
2. Effectively coordinate coverage referrals and compliance related issues with Third Party Administrators (“TPAs”), Claim Management, and our Compliance Department.
3. Provide oversight, guidance, and direction to TPA claim adjusters in accordance with AXA XL best practices on all major phases of claim handling including coverage, investigation, compensability, medical management, disability management, evaluation/reserving, recovery, and resolution.
4. Collaborate with business partners, as appropriate, on claim management and strategy to help deliver the optimal outcomes and ensure, to the extent possible, that we are in alignment on our evaluation of the exposure and strategy to resolve claims.
5. Collaborate and consult with internal claim resources such as regional practice leaders and claim legal attorneys to ensure the most optimal outcome and mitigate claim expense.
6. Perform claim account management for assigned clients to communicate claim issues and results, participate in the TPA audit process, and collaborate on technical and service issues relating to the TPA performance and the client.
7. Collaborate proactively with internal and external stakeholders regarding claim experience, results, and trends (e.g., pricing actuaries, ceded reinsurance staff, credit risk and underwriters).
8. Provide input into the development of key metrics to support claim audits and assist in the coordination and retention of external counsel, as needed.

What you’ll bring

We’re looking for someone who has these abilities and skills:

• Advanced level claim handling experience involving high value/complex claim management and litigation management.
• Defined expertise in managing catastrophic workers’ compensation claims.
• Multi-jurisdictional (U.S.) experience.
• Demonstrated expertise in designated line(s) of business: Workers’ Compensation.
• Experience managing claims in an unbundled insurance model.
• Ability to positively influence external relationships. Coaches, sets expectations, evaluates, and holds people accountable for delivering.
• Excellent verbal and written communication skills.
• Demonstrated negotiation skills.
• Effective organizational and time management skills.
• Demonstrated strategic thinking and a mindset for continuous improvement of internal processes and positive development of external relationships.
• Effective teamwork and collaboration skills to partner with Regional Practice Leads, Claim Legal, TPAs, and clients to produce desired outcomes, as well as with other internal and external stakeholders such as brokers, actuaries, ceded reinsurance staff, and underwriters to communicate claim results, experience, and trends.

Additional Information

AXA XL, the P&C and specialty risk division of AXA, is known for solving complex risks. We combine comprehensive capital, data-driven insights, leading technology, and top talent to deliver exceptional service across property, casualty, professional, financial lines, and specialty insurance.

Our commitment to diversity and inclusion includes resource groups, flexible working, family benefits, and recognition for our inclusive culture. We offer competitive compensation, benefits, and development opportunities. The salary range for this role in the U.S. is USD 104,000 - 182,000, with actual pay based on skills, experience, and location.