Claims Examiner, Medical Stop Loss, Remote

About the role

The A&H MBU at Crum & Forster is seeking a dedicated and experienced individual to join their team. This role involves reviewing claim submissions, communicating with stakeholders, and managing reserves.

Responsibilities

• 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
• Aid with aggregate accommodation activities and aggregate claim submissions
• Maintain appropriate reporting and communication with team and management regarding your assigned areas of responsibility
• Aid in refining internal claim procedures and recommending improvements to management
• Assist with other duties as assigned

Requirements

• 3+ years medical stop loss claim experience required
• Bachelor’s degree or equivalent experience required
• Strong working knowledge of 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 priorities in a fast-paced environment
• Excellent written and verbal communication skills

Qualifications

• Must be able to work independently and as part of a team
• Must be able to handle confidential information with discretion
• Must be able to work flexible hours as needed
• Must be able to travel as needed

Skills

• Strong analytical and problem-solving skills
• Excellent interpersonal and communication skills
• Proficiency in Microsoft Office Suite

Benefits

• Generous 401K employer match
• Employee Stock Purchase plan with employer matching
• Generous Paid Time Off
• Excellent benefits that go beyond health, dental & vision
• Tuition reimbursement
• Industry-related certifications and professional training
• Dynamic, ambitious, fun and exciting work environment
• Matching donation program and volunteer opportunities
• Employee-driven corporate giving program

Pay

The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $48,300.00 to a maximum of $90,800.00. 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.

Schedule

This role is expected to work full-time and may require some evening and weekend availability.