Job Abstract

Job Description 

AXIS is seeking a Head of A&H Reinsurance Claims to join our Global Reinsurance Claims team reporting to the Global Head of Reinsurance Claims.  As the Head of Accident and Health Reinsurance Claims, you'll oversee all aspects of the claims process related to accident and health reinsurance products. This includes managing a team responsible for reviewing, validating and processing reinsurance claims, ensuring compliance with regulations, as well as fair claims processing. You'll also be responsible for developing and implementing strategies to improve efficiency, cost containment, and enhance customer satisfaction. Additionally, you'll collaborate with other departments, such as underwriting and actuarial, to ensure effective claims management practices. Strong leadership, analytical skills, knowledge of a wide spectrum accident and health products including group health, disability, short term medical, medical stop loss, and managed care products  as well knowledge of the landscape of medical cost containment and management vendors are essential for this role. 

KEY DUTIES & RESPONSIBILITIES 

• Direct management of the global A&H reinsurance claims team 

•  Ensuring accurate and consistent claims management and reporting across all A&H Re underwriting segments and lines of business. 

• Actively coaching and mentoring direct reports, providing regular feedback, and developing employees for broader roles and responsibilities that support professional growth and development. 

• Building and maintaining key relationships with internal stakeholders (e.g., peers, Underwriting, Actuarial, various executive management leaders) and external stakeholders (e.g., brokers, insureds, attorneys, auditors, cedents, MGAs, TPAs, and vendors) 

• Coordinating with the Global Head of Reinsurance Claims, to deliver best in class customer service over of all lines of AXIS Accident & Health reinsurance business (North American and International) including but not limited to:  

• Timely reinsurance claim review and validation 

• Managing costs and continuously improve operations. 

• Engaging in the health benefits industry to develop and enhance our cost containment and medical management vendors. 

• Support cedents and their business partners in obtaining the best possible outcomes for their clients with complex claim review, analysis and support as needed.  

• Managing and perform audits of cedents and or their third party administrators for quality claims service and accurate reinsurance reporting.  Develop and execute on post-audit Management Action Plans (MAP) as needed.  

• Lead and foster a change, transformation mindset supporting claims improvement and growth aligned to Underwriting strategy and growth plans. 

• Maintain guidelines, practices and procedures and benefit clarifications for Accident & Health Claims. 

• Ensure timely notification to key stakeholders of reserving activity and claims activity showing trends and developments. 

• Fostering a diverse and inclusive team and environment. 

Successful candidates will possess the following skills/capabilities: 

• Demonstrated leadership skills in cross-functional work via collaboration, negotiation, influence, and teamwork involving core operating functions (e.g., reinsurance and insurance claims management, claims operations, technical accounting, underwriting, and actuarial, etc.). 

• Demonstrated ability to review, analyze and apply health insurance policy or plan document provisions;  

• Working knowledge of A&H reinsurance products and services. 

• Strong analytical skills to support review and application of all related contract terms and conditions to the reinsurance claims presentation.   

• Demonstrated ability to influence and collaborate at all organizational levels, both internally and externally as well as the ability to identify and resolve complex issues 

• Understanding of and ability to balance both the immediate claim issues as well as the broader portfolio impact and customer service impact of coverage disputes and issues 

• Excellent oral and written communication skills with demonstrated ability and experience reporting and presenting to management and clients as well as the ability to deal effectively with people with conflicting expectations and opinions. 

• Demonstrated ability and experience handling A & H claims involving a wide variety of loss scenarios as well as reporting and presenting about same.  

• Ability to identify trends and issues with both individual and portfolio impact and formulating the processes and strategies for handling such claim trends  

• Results driven personality and mindset focused on building a diverse, inclusive team, and demonstrated ability to lead by example. 

• Broad experience working in an accident and health, disability, stop loss or life and health claims leadership role. 

• Effective negotiation and conflict resolution skills to facilitate complex claim settlements and manage people with differing expectations and viewpoints. 

• Bachelor’s degree or equivalent work experience required.  

• ARe, ACI, AHIP or other similar designations preferred. 

• Healthcare experience (nursing, PA, etc.) preferred. 

• International travel may be associated with this role. 

Preferred Locations:  
Princeton, NJ 

Red Bank, NJ 

KEY SKILLS & ABILITIES: 

• Demonstrated leadership, organizational, and management skills. 

• Minimum of 7-10  years of accident and health claims management experience, including experience with TPA managed claims 

• Stop Loss and or reinsurance claims experience preferred  

• Makes recommendations for coverage/settlement/disposition of claims.      

• Demonstrated ability to influence and collaborate at all organizational levels, both internally and externally as well as the ability to identify and resolve complex issues 

• Analytical thinker that can drive results using all facets of the processes  

• Understanding of and ability to balance both the immediate claim issues as well as the broader portfolio impact and customer service impact of coverage disputes and issues 

• Excellent oral and written communication skills with the ability to deal effectively with people with conflicting expectations, differing opinions, and multiple viewpoints  

• Demonstrated ability and experience handling A & H claims involving a wide variety of loss scenarios as well as reporting and presenting about same to senior management.  

• Bachelor’s degree is preferred.  

• Travel is associated with this role (e.g., team management, client presentations, and audits)