Title: Senior Accident & Health Claims Specialist

Location: Remote (Occasional travel required)
Job Type: Full-time
Industry: Insurance/Reinsurance

About Us:
Join a leading insurance and reinsurance provider, offering innovative solutions in Accident & Health claims. We're seeking an experienced Senior Accident & Health Claims Specialist to join our team. This role will involve managing claims, collaborating with vendors, and ensuring alignment with our business goals.

Key Responsibilities:

• Review and process Accident & Health claims; interpret reinsurance contracts and policy language.
• Analyze claim eligibility, coverage issues, and ensure proper provisions and limits.
• Work with vendors, brokers, and clients to resolve claims issues.
• Lead claims committees, report on large losses, and present recommendations to management.
• Maintain accurate claim records and ensure timely reimbursements.
• Participate in industry events and ongoing professional development.

Requirements:

• 10+ years of experience in Accident & Health claims (HMO reinsurance, Stop Loss, Managed Care).
• Proficiency with reinsurance treaties, policy interpretation, and Microsoft Excel.
• Strong analytical, problem-solving, and communication skills.
• Ability to work independently and collaboratively across teams.
• Bachelor's Degree or equivalent experience in insurance, reinsurance, or financial services.