MBU Program Claims Leader - Eatontown, NJ or Remote

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.

Information about the Role, Line of Business and Team:

The successful candidate will work as part of the Operations team to proactively manage a team of claims professionals including the Claims Program Management teams, Training & Development team, and oversight of Stop Loss and Travel vertical operations.  This candidate with be tasked with implementing and managing a long-term strategy that aligns to the division’s objectives.

What you will do:

• Develop long-term plan for the Medical Business Unit program claims organization as the division continues its growth path
• Establish and monitor benchmarks and metrics for effective oversight and team performance
• Develop and provide innovative solutions that provide strategic impact to the division and deliver on approved strategic roadmap initiatives
• Cultivate and maintain excellent relationships with reinsurers, business units and client partners
• Establish, negotiate and maintain vendor relationships and contracts that have a direct impact on divisional results
• Collaborate with management team on planning, staffing and budgeting
• Manage audit process that integrates meaningful quality standards, validates appropriate controls and provides value to the division and client partners
• Work with vertical partners to ensure alignment with divisional objectives and standards; on an ongoing basis monitor that alignment
• Manage assignment of work/division of responsibilities to ensure that client needs are being met and response times managed to standards
• Provide directions to staff on litigated, complex and potential high exposure claims
• Prepare detailed reports summarizing results of risk management reviews of specific clients as needed but no less often than monthly
• Prepare portfolio analysis summary reports for delivery to management in Operations and the Business Unit monthly
• Partner with Analytics to identify persistent claims error trends and report those trends regularly to management
• Partner with IT team to innovate, test and implement technology solutions that improve efficiency and productivity of the claims team
• Ensure that all Claims administrators are informed of and in adherence to applicable state unfair claims practices laws
• Work with Claims Account Management team to ensure that all customer interactions are documented using appropriate tools with strict adherence to confidentiality agreements, policies and procedures.
• Work with Claims Account Management team, Direct team and verticals to ensure that the process to monitor claim denials Is consistent across the division and being handled within guidelines, consistent with policy provisions and clearly, professionally and courteously communicated to the certificate/policyholder
• Provide the leadership necessary to maintain a motivated, productive and competent team through open communication and delegation of responsibilities and authority.
• Be a team leader and builder who has an eye for talent with the ability to maximize resources and capability to deliver business results.
• Demonstrate strong mentoring, relationship-building, planning and organizational skills.
• Guide and direct team members in their personal and professional development. 
• Drive performance excellence through goal setting, quality feedback, and performance appraisals within the team (midyear and annual).
• Create a working environment where productivity can be sustained and accomplished, and where innovation and personal growth is encouraged and realized.
• Drive and role model the A&H culture, values and C&F core competencies within their teams.
• Other duties and/or projects as assigned.

What YOU will bring to C&F:

• In-depth understanding of medical terminology, healthcare delivery systems, insurance contracts, and legal principles
• Proven ability to manage teams, drive results in a matrix environment, and manage change
• Strong ability to leverage data analytics for decision-making and identifying risk trends
• Highly experienced with all facets of client relations
• Excellent written/verbal communication and presentation skills, and the ability to both disseminate a vision at the highest level and understand the details
• Excellent people management skills
• Ability to successfully manage multiple projects and clients simultaneously
• Ability to work independently
• Demonstrated problem solving ability
• Strong attention to detail

Requirements:

• Bachelor’s degree or equivalent required
• 10+ years’ experience in related Medical Insurance claims roles (Medical Stop Loss or Medical Excess)
• 5+ years of medical program claims experience, specifically within medical, healthcare, or pharmacy benefit management in any combination of carrier, TPA or MGU environment
• 3+ years in a leadership role with experience managing people
• Advance knowledge in Microsoft Office tools – Outlook, Excel, Word and PowerPoint
• Ability to work in a fast-paced environment and adaptable
• Ability to travel 

• 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 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.

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 $150,000.00 to a maximum of $238,700.00. 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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