Claims Examiner, Medical Stop Loss, Remote

Crum & Forster (C&F) provides market leading property & casualty, accident & health, specialty and standard commercial lines insurance solutions. A true underwriting company, we have a 200-year history of helping our customers manage risk with laser-focused expertise, integrity and discipline. Our people are empowered to make decisions and problem-solve with you smartly and swiftly. Our annual gross written premium is 6.2 billion.

C&F enjoys a financial strength rating of "A+" (Superior) by AM Best.

Our most valuable asset is our people. We have 3000 employees, and locations throughout the United States and India. With our employee-first focus, the Company is consistently recognized as a great place to work, earning multiple workplace and wellness awards, including the Great Place to Work® Award, Fortune 100 Best Companies to Work For, Fortune Best Workplaces for Parents, Fortune Best Workplaces for Millennia ls, and many others.

C&F is part of Fairfax Financial Holdings. For more information about C&F, please visit our website:

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 2025, the MBU recorded $1.02 Billion in gross premium written.

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 successful candidate will work as part of a team and be responsible for evaluating claim eligibility, outlining claim exposure, processing payments to policyholders, and maintaining appropriate reporting to management.

This individual will interact internally with fellow team members and externally with the division’s business partners. The C&F SL team has an objective to write and administer $2 billion in business in the next 5 years.

What you will do for C&F:

• Within documented authority levels, review all claim submissions for accuracy, completeness, and compliance with various Plan Documents, SPDs, and Policies
• Clearly and professionally communicate external requests for information and maintain timely follow-up
• Clearly and professionally communicate claim payment and denial decisions
• Confirm appropriate disclosure when applicable
• Calculate and maintain reserves as needed
• Assist with aggregate accommodation activities and aggregate claim submissions
• Maintain appropriate reporting and communication with team and management regarding your assigned areas of responsibility
• Assist with refining internal claim procedures and recommending improvements to management
• Other duties as assigned

What you will bring to C&F

• 3+ years medical stop loss claim experience required
• Bachelor’s degree or equivalent experience required
• Strong working knowledge of both Microsoft Office suite with an aptitude to learn new programs (ESL Office experience preferred)
• Ability to establish a good rapport with all stakeholders
• Commitment to delivering outstanding customer service and satisfaction
• Commitment to exploring and assisting in implementing new processes to increase effectiveness and achieve organizational goals
• Exceptional attention to detail and accuracy
• Capability to manage multiple…