Claims Examiner, Medical Stop Loss
WFA Digital Insight
As the demand for skilled claims examiners in the medical stop loss sector continues to rise, with a notable 25% increase in job postings over the past year, professionals with strong analytical and communication skills are in high demand. Crum & Forster, a company with a history dating back to 1822 and a strong financial strength rating, is seeking a Claims Examiner to join its team. With the insurance market evolving rapidly, candidates who can adapt to new processes and technologies will have a competitive edge. Before applying, it's crucial for candidates to understand the importance of attention to detail and excellent customer service skills in this role, as well as the company's commitment to diversity, equity, and inclusion.
Job Description
About the Role
The Claims Examiner, Medical Stop Loss role at Crum & Forster is a unique opportunity to work with a high-quality team of leaders in the insurance industry. The successful candidate will be responsible for evaluating claim eligibility, outlining claim exposure, and processing payments to policyholders. This role is part of the Accident & Health division, which has offered a diverse portfolio of specialty insurance and reinsurance products nationwide since 2000. The division's focus on product development, creative distribution methods, and excellent client service makes it an attractive option for professionals looking to grow in their careers.As part of the team, the Claims Examiner will interact internally with fellow team members and externally with the division's business partners. The company's objective to write and administer $2 billion in business in the next 5 years presents an exciting challenge for the right candidate. With a strong focus on customer service and a commitment to delivering outstanding results, this role is ideal for someone who is detail-oriented, organized, and able to work in a fast-paced environment.
What You Will Do
- Review all claim submissions for accuracy, completeness, and compliance with various Plan Documents, SPDs, and Policies
- Communicate external requests for information and maintain timely follow-up
- Communicate claim payment and denial decisions clearly and professionally
- 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 the team and management regarding assigned areas of responsibility
- Assist with refining internal claim procedures and recommending improvements to management
- Other duties as assigned
What We Are Looking For
- 3+ years of medical stop loss claim experience
- Bachelor's degree or equivalent experience
- Strong working knowledge of Microsoft Office suite with an aptitude to learn new programs
- Experience with Excel is highly 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
- Strong analytical and problem-solving skills
- Excellent communication and interpersonal skills
Nice to Have
- Experience working in a similar role within the insurance industry
- Knowledge of insurance regulations and laws
- Certification in a related field, such as claims adjusting
- Experience with claims software and systems
Benefits and Perks
- Competitive salary
- Comprehensive health insurance
- Retirement savings plan
- Paid time off and holidays
- Remote work stipend
- Opportunities for professional development and growth
- Recognition and reward for outstanding performance
- Collaborative and dynamic work environment
How to Stand Out
- Be prepared to provide specific examples of your experience in managing medical stop loss claims and your proficiency in Excel.
- Tailor your resume and cover letter to highlight your analytical, communication, and problem-solving skills.
- Research Crum & Forster's products and services to understand the company's mission and values.
- Practice your communication skills, as this role involves interacting with both internal teams and external partners.
- Consider obtaining certifications or taking courses to enhance your knowledge of the insurance industry and claim procedures.
- Be prepared to discuss your approach to delivering outstanding customer service and how you handle complex or challenging claims.
This is a remote position listed on WFA Digital, the platform for professionals who work from anywhere. Browse more remote jobs across all categories.