Claims Program Manager – A&H Insurance

Crum & Forster

Eatontown, NJ


Crum & Forster Company Overview

Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies.

Approaching $4 billion in written premium as of 2021, C&F enjoys a financial strength rating of “A” (Excellent) by A.M. Best.

C&F is proud of its superior customer service platform and its claims and risk engineering services are recognized as among the best in the industry.

Our most valuable asset is our people – 3000+ employees, and growing, in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning workplace and wellness awards.

C&F is part of Fairfax Financial Holdings, a global organization with $23.8 billion in revenue as of 2021.

For more information about Crum & Forster, please visit our website: .

Job Description

The Operations department of the Crum & Forster Accident & Health segment is looking for a multi-talented individual to join the Operations team. This Program Manager will work as part of the claims team to proactively manage a team of Specialists assigned 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.

Who We Are

Since 2000, the Accident & Health division of Crum & Forster has been offering a unique variety of insurance and reinsurance products nationwide. Our office is located in Eatontown, New Jersey, and is home to a team of highly skilled and diverse individuals. Our in-house expertise includes underwriting, compliance, actuarial, premium and claims administration, loss control, case management and marketing. We place a strong focus on product development and creative distribution methods, along with excellent client service and support.

We feature a business casual, dog friendly work environment in state of the art office space. We are always on the lookout for bright, hardworking people who want to join our team!

What You Will Do

Relationship Management

  • Audit Coordinator
  • Schedule, coordinate & monitor annual audits
    • First level review of all required reports drafted by Program Management Team members
    • Oversight of Program Team member functions including:
  • Assist in creation of a relationship based culture through a broad set of activities that include managing a diverse portfolio of products and administrators on an ongoing basis;
  • Serving 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;
  • Participation in team member’s meetings with clients and address all open issues no less often than monthly;
  • Address technical issues and coordinate with IT team to seek resolutions as needed;
  • Assignment or assist with the Program Management Team’s onboarding of new clients as needed;
  • Establish long term customer relationships through prompt and courteous service

Risk Management

  • Assist in Due Diligence of new program administration business
  • Onsite reviews and assessment
  • Provide Management an operational assessment of prospective partners
    • Assist in annual reviews of administrators to ensure compliance with company requirements while identifying gaps in process and/or areas for potential improvement at both administrator and company;
    • Monitor claims activity to identify any outliers no less often than quarterly;
    • Identify processing, system and/or operational issues within client or company operations in order to ensure claims are paid consistent with policy terms

Reporting / Trend Analysis

  • Prepare monthly reporting package including but not limited to inventory reporting, first level (TPA customer service & turnaround) statistics, referral analysis (turnaround times, volume breakdowns) for review by AVP and Senior Level Management
  • On a monthly basis, provide an analysis of all claims related litigation / regulatory inquiries identifying all trends and exposure
  • On no less than a quarterly basis, provide an analysis of all claims referrals logs to identify trends and recommendations for authority level adjustments as necessary

Legal / Regulatory

  • Refer to and assist as necessary, all small claims litigation to the Legal team
  • Review all attorney correspondence and coordinate responses with administrator
  • Assist Compliance in reviews of claims-related regulatory inquiries

Best Practices / Process Documentation

  • Draft initial documents for internal Claims Best Practices including:
    • Standards – both C&F and regulatory
    • Procedures
    • Workflow
  • Review and update of these practices on no less than a quarterly basis
  • Oversight of Program Management Teams review of TPA Best Practices Ensure that all Claims administrators are informed of and in adherence to applicable state unfair claims practices laws

Training & Development

  • Continuing development of product knowledge on the Program Management Team
  • Relationship skills – assist in the development of Program Management Team to think bigger picture and outside the “claims audit box”
  • Using actual situations (i.e. distressed administrators) as an educational and development tool for Program Management Team members

Key Competencies

  • Interpersonal – Must be able to establish a good rapport with all customers
  • Customer Focused – Able to demonstrate a high level of service delivery; do what is necessary to ensure customer satisfaction; deal with service failures and prioritize customer needs
  • Analytical/Problem Solving – Analyzes relevant aspects of a situation before reaching a conclusion; does not hesitate to take action when required. Explores, develops and implements new methods and processes which increases efficiency and effectiveness to attain achievement of both individual and organizational goals
  • Attention to Detail – Focuses on accuracy when completing all projects
  • Commitment – Provides a sustained effort and dedication to getting the job done well, works continuously to produce superior work regardless of obstacles or setbacks
  • Displays personal concern, interest, pride and accountability in all areas of responsibility
  • Multi-tasking – Must be able to effectively handle multiple tasks in a fast paced environment
  • Strong PC skills including Excel, Word, Outlook, Power Point
  • Ability to work both independently and in a team environment
  • Strong organization and time management skills with exceptional attention to detail
  • Communication – Able to clearly present information through the spoken or written word; read and interpret complex information with moderate supervision

What You Will Bring To C&F

  • Bachelor’s Degree from an Accredited institution with at least 5-7 years’ experienc
    e of relevant medical stop loss or medical excess experience.
  • Experience in specialty products such as Short Term Medical, Medical Travel, Workers Compensation and/or Occupational Accident is preferred

What C&F Will Bring To You

  • 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

We value inclusivity and diversity. 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 accommodation, please let us know.