Claims Examiner- Employer Stop Loss-Remote

Crum & Forster Company Overview:

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.

Information about the Role, Line of Business and Team:

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.

What you will do:

• 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:

• 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

Requirements:

• 3-4 years claim experience preferred (ESL claim experience a plus)
• College degree from an accredited university or equivalent experience required
  
• Strong working knowledge of both Microsoft Office suite and DYS as well as an aptitude to learn new programs

• 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 tenant 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 and welcome everyone regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. If you require a special accommodation, please let us know.

For California Residents Only:  Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit https://www.cfins.com/onlineprivacypolicy/ca/noticeatcollection/ for more information.

Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws.  Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $46,000.00 to a maximum of $86,500.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee’s contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs.

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