Provide exceptional claims service to customers by managing complex medical stop loss claims effectively.
Assess policy coverage, investigate, evaluate, and negotiate claims.
Collaborate with suppliers and stakeholders while offering technical support.
Support the implementation of the Claims strategy to enable the delivery of overall business targets.
Maintain current knowledge of insurance guidelines, policy changes, and modifications.
Maintain good client relationships with insured individuals, agents, service providers, and the general public.
Identify and implement strategies to minimise Claims Costs and Leakage.
Assist with the negotiation of claims settlements.
Participate in relevant meetings to share and develop strategy, knowledge, and best practices.
Identify and resolve issues or anomalies non-compliant with policies and procedures.
Assist with the daily review of reports and ad hoc reporting.
Mentor and coach junior staff as required.

Moderate relevant experience
Experience in an Accident & Health claims department or the insurance industry (preferred)
Experience handling Medical Stop Loss claims (preferred)
Tertiary Degree or equivalent combination of education and work experience (necessary)
Relevant insurance qualifications (necessary)

Hybrid Working – a mix of working from home and in the office
22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis
Competitive 401(k) program with company match up to 8%
Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice
Tuition Reimbursement for professional certifications, and continuing education
Employee Network and Community – QBE actively supports six Employee Networks, and many ways to give back to your community

Claims Specialist – Accident and Health

Key skills