Claims Program Manager

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.

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 Crum & Forster Accident & Health demonstrate our philosophy of building meaningful, long-term partnerships and our dedication to providing alternative strategies in an ever-changing insurance market.

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 team of Specialists assigned to 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.

The position is based in Eatontown, NJ or fully remote.

What you will do for C&F:

Relationship Management:

• Act as an Audit Coordinator, by scheduling, coordinating & monitoring annual audits
• Be the first-level review of all required reports drafted by Program Management Team members
• Have oversight of Program Team member functions including:
  • Assist in the creation of a relationship-based culture through a broad set of activities which include managing a diverse portfolio of products and administrators on an ongoing basis
  • Serve 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
  • Participate 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
  • Assign or assist with the Program Management Team’s onboarding of new clients as needed
  • Establish long term customer relationships through prompt and courteous service

Risk Management

• Assist in Due Diligence of new program administration business, which includes onsite reviews and assessment, while providing 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 the administrator and company level
• 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

Reporting/Trend Analysis

• Prepare monthly reporting packages, including but not limited to, inventory reporting, first level (TPA customer service & turnaround) statistics, and referral analysis (turnaround times, volume breakdowns) for review by AVP and Senior Level Management
• On a monthly basis, provide an analysis of all claims related litigation/regulatory inquiries to identify 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

Legal/Regulatory

• Refer to and assist as necessary, all small claims litigation to the Legal team
• Review all attorney correspondences and coordinate responses with administrator
• Assist Compliance in reviews of claims-related regulatory inquiries

Best Practices/Process Documentation

• Draft initial documents for internal Claims Best Practices including:
  • Standards – both C&F and regulatory
  • Procedures
  • Workflow
• Review and update above practices, on no less than a quarterly basis
• Oversee the Program Management Teams review of TPA Best Practices, to ensure all Claims administrators are informed of and in adherence to applicable state unfair claims practices laws

Training & Development

• Continue development of product knowledge on the Program Management Team
• Assist in the development of Program Management Team to think bigger picture and outside the “claims audit box”
• Utilize actual situations (i.e. distressed administrators) as an educational and development tool for Program Management Team members
• Other duties as assigned

What you will bring to C&F:

• Bachelor’s Degree from an accredited university/institution
• 8+ years’ experience of relevant Medical Stop Loss or Medical Excess experience
• Strong PC skills including Excel, Word, Outlook, Power Point
• Experience in specialty products such as Employer Stop Loss, Travel, Short Term Medical, Medical Travel, Workers Compensation and/or Occupational Accident is preferred
• Ability to establish a good rapport with all customers
• Demonstration of a high level of service delivery and ability to do what is necessary to ensure customer satisfaction, while handling service failures and prioritizing customer needs
• Ability to analyze relevant aspects of a situation before reaching a conclusion, with no hesitation to take action when required
• Ability to explore, develop and implement new methods and processes, which increase efficiency and effectiveness, in order to attain achievement of both individual and organizational goals
• Strong attention to detail with a focus on accuracy when completing all projects
• Ability to provide a sustained effort and dedication to getting the job done well, while working continuously to produce superior work, regardless of obstacles or setbacks
• A display of 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, as well as read and interpret complex information with moderate supervision

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 $87,000.00 to a maximum of $145,000.00. 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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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 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 accommodation, please let us know.