Claims Program Manager, MBU- Eatontown, NJ or Remote

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    "title": "Claims Program Manager, MBU- Eatontown, NJ or Remote",
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    "datePosted": "2024-06-22T08:13:54.561Z",
    "description": "<h2>Crum & Forster Company Overview</h2>\n<p>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.</p>\n<p> </p>\n<p>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.</p>\n<p> </p>\n<p>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.</p>\n<h2>Job Description</h2>\n<p><strong>Information about the Role, Line of Business and Team: </strong></p>\n<p>The Operations department of the Crum & Forster Accident & Health segment is looking for a multi-talented individual to join the Operations team. This Claims Program Manager (Medical Business Unit) will work as part of the claims team 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.</p>\n<p> </p>\n<p><strong>What you will do:</strong></p>\n<p><u>Relationship Management</u>:</p>\n<ul>\n <li>Assist in the creation of a relationship-based culture through a broad set of activities which include managing a diverse portfolio of medical products and administrators on an ongoing basis</li>\n <li>Serve as a “next-step” liaison to administrative, operations, and underwriting areas of the company, on an ongoing basis</li>\n <li>Utilize sensitivity tactics to address relevant issues with distressed customers in a professional manner, on an ongoing basis</li>\n <li>Participate in team member’s meetings with clients and address all open issues no less often than quarterly</li>\n <li>Address technical issues and coordinate with IT team to seek resolutions as needed</li>\n <li>Assist with the Program Management Team’s onboarding of new clients as needed</li>\n <li>Establish long term customer relationships through prompt and courteous service</li>\n</ul>\n<p><u>Risk Management</u></p>\n<ul>\n <li>Assist in Due Diligence of new program administration business, which includes onsite reviews and assessment, while providing Management an operational assessment of prospective partners</li>\n <li>Conduct 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\n  <ul>\n   <li>This includes scheduling, coordinating and monitoring to completion required annual audits</li>\n  </ul></li>\n <li>Monitor claims activity to identify any outliers, no less often than quarterly</li>\n <li>Identify processing, system and/or operational issues within client or company operations to ensure claims are paid consistently with policy terms</li>\n</ul>\n<p><u>Reporting/Trend Analysis</u></p>\n<ul>\n <li>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 VP / AVP / Director and Senior Level Management</li>\n <li>Assist with the monthly analysis of all claims related litigation/regulatory inquiries and/or high dollar claims to identify all trends and exposure</li>\n</ul>\n<p><u>Legal/Regulatory</u></p>\n<ul>\n <li>Refer to and assist as necessary, all small claims litigation to the Legal team</li>\n <li>Review all attorney correspondences and coordinate responses with administrator </li>\n <li>Assist Compliance in reviews of claims-related regulatory inquiries</li>\n</ul>\n<p><u>Best Practices/Process Documentation</u></p>\n<ul>\n <li>Assist in the drafting and maintenance of reference documents for internal Claims Best Practices including:\n  <ul>\n   <li>Standards – both C&F and regulatory</li>\n   <li>Procedures</li>\n   <li>Workflow</li>\n  </ul></li>\n</ul>\n<p><u>Training & Development</u></p>\n<ul>\n <li>Continue self-development of product knowledge on the Claims Program Management Team</li>\n <li>Other duties as assigned</li>\n</ul>\n<p><strong>What YOU will bring to C&F:</strong></p>\n<ul>\n <li>Ability to establish a good rapport with all customers, partners and stakeholders</li>\n <li>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</li>\n <li>Ability to leverage data / reports / data analytics for decision-making and identifying risk trends</li>\n <li>Ability to analyze relevant aspects of a situation before reaching a conclusion, with no hesitation to act when required</li>\n <li>Strong attention to detail with a focus on accuracy when completing all projects</li>\n <li>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</li>\n <li>A display of personal concern, interest, pride and accountability in all areas of responsibility</li>\n <li>Ability to effectively handle multiple tasks in a fast-paced environment</li>\n <li>Ability to work both independently and in a team environment</li>\n <li>Strong organization and time management skills with exceptional attention to detail</li>\n <li>Ability to clearly present information through the spoken or written word, as well as read and interpret complex information with moderate supervision</li>\n</ul>\n<p> </p>\n<p><strong>Requirements:</strong></p>\n<ul>\n <li>Bachelor’s Degree from an accredited university/institution</li>\n <li>6+ years’ experience of relevant Medical Stop Loss or Medical Excess Experience</li>\n <li>Experience in specialty products such as Employer Stop Loss, Short Term Medical, Medical Excess, Fixed Indemnity, and Life is preferred</li>\n <li>Strong knowledge of Microsoft Office tools – Outlook, Excel, Word and PowerPoint</li>\n <li>Ability to work in a fast-paced environment and adaptable</li>\n <li>Ability to travel (up to 40%)</li>\n</ul>\n<h2>What C&F will bring to you</h2>\n<ul>\n <li>Competitive compensation package</li>\n <li>Generous 401K employer match</li>\n <li>Employee Stock Purchase plan with employer matching</li>\n <li>Generous Paid Time Off</li>\n <li>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</li>\n <li>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</li>\n <li>A dynamic, ambitious, fun and exciting work environment</li>\n <li>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 </li>\n</ul>\n<p><strong>At C&F you will BELONG</strong></p>\n<p> </p>\n<p>If you require special accommodations, please let us know. 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. Belonging at C&F, is a mindset. It’s about fostering a culture of inclusion and connection, where everyone feels valued, heard, and empowered to thrive and where our social impact efforts help strengthen the communities where we live and work. </p>\n<p> </p>\n<p>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. </p>\n<p> </p>\n<p>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 $58,700.00 to a maximum of $110,200.00. 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.</p>\n<p> </p>\n<p>#LI-BS1</p>\n<p>#LI-REMOTE</p>",
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    "responsibilities": "Information about the Role, Line of Business and Team: \r\nThe Operations department of the Crum & Forster Accident & Health segment is looking for a multi-talented individual to join the Operations team. This Claims Program Manager (Medical Business Unit) will work as part of the claims team 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.\r\n \r\nWhat you will do:\r\nRelationship Management:\r\n- Assist in the creation of a relationship-based culture through a broad set of activities which include managing a diverse portfolio of medical products and administrators on an ongoing basis\r\n- Serve as a “next-step” liaison to administrative, operations, and underwriting areas of the company, on an ongoing basis\r\n- Utilize sensitivity tactics to address relevant issues with distressed customers in a professional manner, on an ongoing basis\r\n- Participate in team member’s meetings with clients and address all open issues no less often than quarterly\r\n- Address technical issues and coordinate with IT team to seek resolutions as needed\r\n- Assist with the Program Management Team’s onboarding of new clients as needed\r\n- Establish long term customer relationships through prompt and courteous service\r\nRisk Management\r\n- Assist in Due Diligence of new program administration business, which includes onsite reviews and assessment, while providing Management an operational assessment of prospective partners\r\n- Conduct 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\r\n- This includes scheduling, coordinating and monitoring to completion required annual audits\r\n\r\n- Monitor claims activity to identify any outliers, no less often than quarterly\r\n- Identify processing, system and/or operational issues within client or company operations to ensure claims are paid consistently with policy terms\r\nReporting/Trend Analysis\r\n- 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 VP / AVP / Director and Senior Level Management\r\n- Assist with the monthly analysis of all claims related litigation/regulatory inquiries and/or high dollar claims to identify all trends and exposure\r\nLegal/Regulatory\r\n- Refer to and assist as necessary, all small claims litigation to the Legal team\r\n- Review all attorney correspondences and coordinate responses with administrator \r\n- Assist Compliance in reviews of claims-related regulatory inquiries\r\nBest Practices/Process Documentation\r\n- Assist in the drafting and maintenance of reference documents for internal Claims Best Practices including:\r\n- Standards – both C&F and regulatory\r\n- Procedures\r\n- Workflow\r\n\r\nTraining & Development\r\n- Continue self-development of product knowledge on the Claims Program Management Team\r\n- Other duties as assigned\r\nWhat YOU will bring to C&F:\r\n- Ability to establish a good rapport with all customers, partners and stakeholders\r\n- 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\r\n- Ability to leverage data / reports / data analytics for decision-making and identifying risk trends\r\n- Ability to analyze relevant aspects of a situation before reaching a conclusion, with no hesitation to act when required\r\n- Strong attention to detail with a focus on accuracy when completing all projects\r\n- 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\r\n- A display of personal concern, interest, pride and accountability in all areas of responsibility\r\n- Ability to effectively handle multiple tasks in a fast-paced environment\r\n- Ability to work both independently and in a team environment\r\n- Strong organization and time management skills with exceptional attention to detail\r\n- Ability to clearly present information through the spoken or written word, as well as read and interpret complex information with moderate supervision\r\n \r\nRequirements:\r\n- Bachelor’s Degree from an accredited university/institution\r\n- 6+ years’ experience of relevant Medical Stop Loss or Medical Excess Experience\r\n- Experience in specialty products such as Employer Stop Loss, Short Term Medical, Medical Excess, Fixed Indemnity, and Life is preferred\r\n- Strong knowledge of Microsoft Office tools – Outlook, Excel, Word and PowerPoint\r\n- Ability to work in a fast-paced environment and adaptable\r\n- 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