Claims Program Manager, MBU- Eatontown, NJ or Remote

About the role

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.

Responsibilities

• Aid 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.
• 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.
• Maintain 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.
• Legal/Regulatory: 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.
• Best Practices/Process Documentation: Assist in the drafting and maintenance of reference documents for internal Claims Best Practices including: Standards – both C&F and regulatory Procedures Workflow Training & Development: Continue self-development of product knowledge on the Claims Program Management Team.
• Other duties as assigned.

Requirements

• Bachelor’s Degree from an accredited university/institution
• 6+ years’ experience of relevant Medical Stop Loss or Medical Excess Experience
• Experience in specialty products such as Employer Stop Loss, Short Term Medical, Medical Excess, Fixed Indemnity, and Life is preferred
• Strong knowledge of Microsoft Office tools – Outlook, Excel, Word and PowerPoint
• Ability to work in a fast-paced environment and adaptable
• Ability to travel (up to 40%)

Qualifications

• Ability to establish a good rapport with all customers, partners and stakeholders
• 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
• Leverage data / reports / data analytics for decision-making and identifying risk trends
• Analyze relevant aspects of a situation before reaching a conclusion, with no hesitation to act when required
• Strong attention to detail with a focus on accuracy when completing all projects
• Provide a sustained effort and dedication to getting the job done well, while working continuously to produce superior work, regardless of obstacles or setbacks
• A display of personal concern, interest, pride and accountability in all areas of responsibility
• Effectively handle multiple tasks in a fast-paced environment
• Work both independently and in a team environment
• Strong organization and time management skills with exceptional attention to detail
• Clearly present information through the spoken or written word, as well as read and interpret complex information with moderate supervision