Claim Operations Specialist

$85,000 - $100,000/Yr

Axis Capital - Princeton, NJ

posted 5 months ago

Full-time - Mid Level
Princeton, NJ
Insurance Carriers and Related Activities

About the position

This position at AXIS Capital is for a Claims TPA Operations Specialist within the TPA Programs North America Claims team. The successful candidate will report directly to the Head of TPA & Program Claims and will play a crucial role in supporting the development and execution of a TPA & Program claims service model for Axis North America. The role requires a proactive problem-solver and self-starter who can manage a variety of responsibilities related to the holistic management of Third Party Administrators (TPAs) for North America Claims. The Claims TPA Operations Specialist will facilitate relationships between TPAs and Axis North America Claims, as well as other internal stakeholders such as Legal, Finance, Quality Assurance, and Data & Analytics. This includes managing the commercial relationship stages, which encompass due diligence assessments, contract negotiations, onboarding, offboarding, claims audits, and loss fund management. The specialist will also be responsible for identifying and mitigating risks, managing workflow, and resolving operational issues related to the TPA & Program Claims management environment. In addition, the role involves scheduling and coordinating meetings with TPAs and stakeholders, building relationships, and tracking action plans. The specialist will provide regular dashboard reporting on TPA & Program claim metrics, financial impacts, and overall results. They will drive initiatives to improve data acquisition and analytics, collaborating with TPAs and internal stakeholders to enhance reporting, KPIs, and scorecards. Furthermore, the specialist will develop and update policies, standards, processes, and documentation of best practices for TPA & Program claims in collaboration with North America Claims leadership, while also facilitating quality and compliance reviews with Claims Quality Assurance.

Responsibilities

  • Support the Head of Program Claims with holistic management of TPAs for North America Claims.
  • Facilitate TPA relationships and interactions with Axis North America Claims and other internal stakeholders.
  • Manage commercial relationship stages including due diligence assessment, contract negotiation, onboarding, offboarding, claims audits, and loss fund management.
  • Identify and mitigate risks, manage workflow, and resolve operational issues related to TPA & Program Claims management.
  • Schedule and coordinate meetings with TPAs and required stakeholders, building relationships and tracking action plans.
  • Provide monthly, quarterly, and yearly dashboard reporting on TPA & Program claim metrics and financial impacts.
  • Drive initiatives to improve data acquisition, analytics, and reporting metrics related to TPAs.
  • Develop and update policies, standards, processes, and documentation of best practices for TPA & Program claims.
  • Collaborate with Claims Quality Assurance and Compliance to facilitate quality and compliance reviews.

Requirements

  • 3-5 years of experience with TPA managed claims in P&C commercial claims or reinsurance organizations.
  • Ability to analyze data and make practical decisions in a dynamic environment.
  • Excellent communication skills and experience supporting strategic initiatives.
  • Experience working on cross-functional teams and delivering solutions.
  • Strong organizational, critical thinking, problem solving, analytical, and quantitative skills.
  • Proven prioritization skills to balance immediate needs with broader organizational strategies.
  • Ability to identify and escalate issues that could present challenges to projects or the organization.
  • College degree or relevant experience is a plus.

Nice-to-haves

  • Experience in claims oversight operational management or transferable experience.

Benefits

  • Medical plans for employees and their families
  • Health and wellness programs
  • Retirement plans
  • Tuition reimbursement
  • Paid vacation
  • Competitive incentive targets based on performance.
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