Primary Details
Time Type: Full time
Worker Type: Employee

AVP, A&H Claims

• Location: USA – MA –Marblehead & GA-Atlanta
• Work Arrangement: Hybrid
• The salary range for this role is: $ 149,500-224.500

The Opportunity
The purpose of this role is to oversee the operational and technical aspects of a team of Accident & Health Claim Specialists, ensuring efficient handling of Medical Stop Loss claims through best practices. This role involves driving continuous improvement initiatives to enhance quality and service while building strong relationships with both internal stakeholders and customers.

Responsibilities:

• Establish methods and procedures to manage, supervise, and direct the claims operations in a cost-effective manner
• Set department goals and policies in conjunction with business plans to ensure objectives are met
• Identify, analyze, recommend and implement process improvements in functional areas
• Achieve specific key performance indicators and strive to find better ways to improve overall service delivery
• Act as a critical point of escalation on complex, denied or pending claims
• Maintain current knowledge of products and services to provide direction and respond to issues
• Cultivate positive relationships with internal and external customers to accomplish organizational goals
• Assess present and future resource needs for employees and provide the leadership, mentoring and guidance necessary to build and sustain a high performing workforce
• Manage budgeted resources by anticipating expenditures, accurately forecasting resource needs/costs and properly accounting for expenses to meet requirements and achieve fiscal responsibility

Work Experience:

Preferred Work Experience includes:

• 8 plus years of Accident & Health Medical Stop Loss claim experience required.
• 2 plus years of people management experience required.
• Significant exposure to high risk and/or high value Specific Excess Claims
• Experience reviewing Aggregate Accommodation requests and Aggregate Claim submissions.
• Highly proficient in Microsoft Office and the Connexure/ESL system.

Qualifications:

Necessary Qualifications include:

• Tertiary Degree or equivalent combination of education and work experience.

Compensation Package: The salary range for this role is provided above. The salary offer will be decided based on the role’s complexity, its location, and the candidate’s professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE’s annual discretionary bonus plan based on business and individual performance.

Benefits

• Hybrid Working – a mix of working from home and in the office.
• 22 weeks of paid leave depending on the circumstances in growing your family with 12 of those weeks available to all parents, on a gender-equal basis
• Competitive 401(k) program with company match up to 8%
• Well-being Programs: Enjoy monthly Guided Meditations and a Well-being Rebate Program for gym memberships, fitness programs, and more.
• Tuition Reimbursement for continuing education through certifications, external professional development and degree related college courses.

To learn more, click here:
Benefits | QBE US
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Why QBE? What if you could have a positive impact – at work and in the world?
At QBE, we’re enabling a more resilient future – for our customers, communities, environment, and for our people. We’re building momentum to achieve something significant and know our people are at the center of our success.
Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you’ll get to spend every day working with people who are passionate, talented and kind. And our international scale means we’re big enough for your ambitions, yet small enough for you to make a real impact.
Join us now, so you can be part of our success – and we can be part of yours!
https://www.linkedin.com/company/qbe-north-america/
Commitment to Diversity
At QBE, we are deeply committed to fostering an inclusive workplace where each person is valued and respected for their authentic selves. If you require any assistance, such as alternative interview accommodation during the recruitment process, please do not hesitate to inform our Talent Acquisition team.
Equal Employment Opportunity:
QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.
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Skills:
Adaptability, Claims Settlement, Critical Thinking, Data Management, Insurance Claims Management, Insurance Claims Processing, Intentional collaboration, Managing performance, Negotiation, Personal Initiative, Presenting with Impact, Regulatory Compliance, Risk Management, Sound Judgment, Stakeholder Management
How to Apply:
To submit your application, click “Apply” and follow the step by step process.
Equal Employment Opportunity:
QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates

• Establish methods and procedures to manage, supervise, and direct the claims operations in a cost-effective manner
• Set department goals and policies in conjunction with business plans to ensure objectives are met
• Identify, analyze, recommend and implement process improvements in functional areas
• Achieve specific key performance indicators and strive to find better ways to improve overall service delivery
• Act as a critical point of escalation on complex, denied or pending claims
• Maintain current knowledge of products and services to provide direction and respond to issues
• Cultivate positive relationships with internal and external customers to accomplish organizational goals
• Assess present and future resource needs for employees and provide the leadership, mentoring and guidance necessary to build and sustain a high performing workforce
• Manage budgeted resources by anticipating expenditures, accurately forecasting resource needs/costs and properly accounting for expenses to meet requirements and achieve fiscal responsibilit