Crum & Forster (C&F) 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.

C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: www.cfins.com.

Claims Program Manager, Medical Stop Loss (Remote or Eatontown, NJ)

The Operations department of the Crum & Forster Accident & Health segment is looking for a multi-talented individual to join the Operations team. This Program Manager will work as part of the claims team to proactively manage a portfolio of claim clients (Third Party Administrators and Managing General Underwriters) while performing oversight and enhancing the client relationship by identifying and resolving process issues in all phases of the client's and company's operations. This individual will interact internally with Underwriting, Actuarial, Compliance, IT, and externally with the divisions business partners.

What you will do:

Schedule, coordinate & monitor annual audits
• Assist in creation of a relationship based culture through a broad set of activities that include managing a diverse portfolio of products and administrators on an ongoing basis
• Serving as a "next-step" liaison to administrative, operations, and underwriting areas of the company on an ongoing basis
• Utilize sensitivity tactics to address relevant issues with distressed customers in a professional manner on an ongoing basis
• Participation in team member's meetings with clients and address all open issues no less often than monthly
• Address technical issues and coordinate with IT team to seek resolutions as needed
• Assignment or assist with the Program Management Team's onboarding of new clients as needed
• Establish long term customer relationships through prompt and courteous service
• Assist in Due Diligence of new program administration business; Onsite reviews and assessment, Provide Management an operational assessment of prospective partners
• Assist in annual reviews of administrators to ensure compliance with company requirements while identifying gaps in process and/or areas for potential improvement at both administrator and company
• Monitor claims activity to identify any outliers no less often than quarterly
• Identify processing, system and/or operational issues within client or company operations in order to ensure claims are paid consistent with policy terms
• Prepare monthly reporting package including but not limited to inventory reporting, first level (TPA customer service & turnaround) statistics, referral analysis (turnaround times, volume breakdowns) for review by VP and Senior Level Management
• On a monthly basis, provide an analysis of all claims related litigation / regulatory inquiries identifying all trends and exposure
• On no less than a quarterly basis, provide an analysis of all claims referrals logs to identify trends and recommendations for authority level adjustments as necessary
• Refer to and assist as necessary, all small claims litigation to the Legal team
• Review all attorney correspondence and coordinate responses with administrator
• Assist Compliance in reviews of claims-related regulatory inquiries
• Provide assistance with drafting of documents for internal Claims Best Practices including; Standards - both C&F and regulatory, procedures, and workflow
• Provide assistance in the review and update of these practices on no less than a quarterly basis
• Continuing development of product knowledge on the Program Management Team

What YOU will bring to C&F:

• Bachelor's Degree from an Accredited institution with at least 8+ years' experience of relevant A&H insurance experience
• Experience in any specialty products such as Short Term Medical, Fixed Indemnity, Stop Loss, Medical Excess, Medicare Supplement is preferred
  
• Ability to establish a good rapport with all customers
• Ability to demonstrate a high level of service delivery; do what is necessary to ensure customer satisfaction; deal with service failures and prioritize customer needs
• Proficient analytical/problem solving skills
• Ability to explore, develop and implement new methods and processes which increases efficiency and effectiveness to attain achievement of both individual and organizational goals
• Strong attention to detail
• Provide a sustained effort and dedication to getting the job done well, work continuously to produce superior work regardless of obstacles or setbacks
• Display personal concern, interest, pride and accountability in all areas of responsibility
• Ability to effectively handle multiple tasks in a fast-paced environment
• Ability to work both independently and in a team environment
• Strong organization and time management skills with exceptional attention to detail
• Ability to clearly present information through the spoken or written word; read and interpret complex information with moderate supervision
• Ability to travel (20%)

#LI-MS

#LI-REMOTE

• 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

If you require special accommodations, please let us know.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 special accommodations, please let us know