Claims Program Manager, MBU- Eatontown, NJ or Remote

Crum & Forster Company Overview

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 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.

• 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
• 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 quarterly
• Address technical issues and coordinate with IT team to seek resolutions as needed
• 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, which includes onsite reviews and assessment, while providing Management an operational assessment of prospective partners
• 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
  • This includes scheduling, coordinating and monitoring to completion required annual audits
• Monitor claims activity to identify any outliers, no less often than quarterly
• Identify processing, system and/or operational issues within client or company operations to ensure claims are paid consistently with policy terms

• 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
• Assist with the monthly analysis of all claims related litigation/regulatory inquiries and/or high dollar claims to identify all trends and exposure

• 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

• Assist in the drafting and maintenance of reference documents for internal Claims Best Practices including
  • Standards – both C&F and regulatory
  • Procedures
  • Workflow

• Continue self-development of product knowledge on the Claims Program Management Team
• Other duties as assigned

• Ability to establish a good rapport with all customers, partners and…