Current jobs related to Claims Examiner Stop Loss - Eatontown - Crum & Forster

Crum & Forster Company Overview:
Crum & Forster (C&F) with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A" (Excellent) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry.

Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the October 2022 Great Place to Work® Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion.

**Job Description**:
Since 2000, Crum & Forster’s Accident & Health division (A&H) has offered a diverse portfolio of specialty insurance and reinsurance products nationwide. We place a strong focus on product development and creative distribution methods, along with excellent client service and support.

In addition to our robust domestic portfolio, which spans both special risk and medical solutions, A&H works on an international basis through various partnerships. Our global capabilities provide our partners with even broader flexibility in underwriting solutions.

The qualities and capabilities of A&H demonstrate our philosophy of building meaningful, long-term partnerships and our dedication to providing alternative strategies in an ever-changing insurance market.

The A&H MBU takes a full-spectrum approach to designing and servicing a robust slate of products tailored to needs in Employer Stop Loss, Excess Medical, Life, and Ancillary and Supplemental benefits. Our diversified business model includes program partnerships as well as direct sales in Employer Stop Loss. At year-end 2023, the MBU recorded $741M in gross premium written.

This is a unique opportunity to work with a high-quality team of leaders and benefit from the security and stability of a large organization while maintaining a nimble and responsive approach to business. The Claim Examiner evaluates claim eligibility, outlines claim exposure, processes payments to policyholders, and provides and maintains appropriate reporting to management. This individual will interact internally with Underwriting, Actuarial, Compliance, IT, and externally with the division’s business partners.

This is a fully remote position based in the U.S.

**What you will do for C&F**:

- Review all claim submissions for completeness, accuracy, and conformance to the Plan Document, SPD, and Policy
- Communicate all necessary follow-up with TPAs and other parties.
- Confirm appropriate disclosure when applicable.
- Calculate and maintain reserves as needed.
- Communicate all payment or denial decisions in a clear and professional manner.
- Monitor Aggregate Accommodation activity and review aggregate claim submissions.
- In conjunction with the Claim Manager, develop and enhance claim procedures to communicate to TPAs for Employer Stop Loss business (ESL)
- Maintain appropriate reporting and communication with team and management regarding your assigned areas of responsibility.
- Other duties as assigned.

**What you will bring to C&F**:

- 3-4 years claims experience required (ESL claims experience a plus)
- College degree or equivalent experience required.
- Strong working knowledge of both Microsoft Office suite and DYS as well as an aptitude to learn new programs.
- Ability to establish a good rapport with all stakeholders.
- High level of service, customer satisfaction, and prioritization of needs
- Explore, develop, and implement new processes to increase effectiveness and achieve organizational goals.
- Focus on accuracy and attention to detail.
- Manage multiple tasks in a fast-paced environment.
- Excellent written and verbal communication skills

What C&F will bring to you:
Competitive compensation package

Generous 401K employer match

Employee Stock Purchase plan with employer matching

Generous Paid Time Off

Excellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeing

A core C&F tenet is owning your career development, so we provide a wealth of ways for you to keep learning, including tuition reimbursement, industry-related certifications and professional training to keep you progressing on your chosen path

A dynamic, ambitious, fun and exciting work environment

We believe you do well by doing good and want to encourage a spirit of social and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community.

**At C&F you will BELONG**

We value inclusivity and diversity. We are committed to equal employment opportunity