MBU Program Claims Leader - Eatontown, NJ or Remote

Crum & Forster•Eatontown, NJ

7d•Remote

About The Position

The MBU Program Claims Leader will be part of the Operations team, proactively managing a team of claims professionals including Claims Program Management, Training & Development, and oversight of Stop Loss and Travel vertical operations. This role involves implementing and managing a long-term strategy aligned with the division’s objectives, developing innovative solutions, and cultivating strong relationships with reinsurers, business units, and client partners. The leader will also establish and negotiate vendor contracts, collaborate on planning, staffing, and budgeting, and manage audit processes to ensure quality standards and controls. Additionally, this position requires ensuring alignment with divisional objectives, managing work assignments to meet client needs and response times, providing direction on complex claims, and preparing detailed reports on risk management reviews and portfolio analysis. The role also involves partnering with Analytics and IT to identify trends and implement technology solutions, ensuring adherence to state unfair claims practices laws, and working with the Claims Account Management team to ensure proper documentation and consistent handling of claim denials. A key aspect of this role is providing leadership to maintain a motivated, productive, and competent team through open communication, delegation, mentoring, and driving performance excellence. The leader will foster a working environment that encourages innovation and personal growth, and will role model the A&H culture, values, and C&F core competencies.

Requirements

Bachelor’s degree or equivalent required
10+ years’ experience in related Medical Insurance claims roles (Medical Stop Loss or Medical Excess)
5+ years of medical program claims experience, specifically within medical, healthcare, or pharmacy benefit management in any combination of carrier, TPA or MGU environment
3+ years in a leadership role with experience managing people
Advance knowledge in Microsoft Office tools – Outlook, Excel, Word and PowerPoint
Ability to work in a fast-paced environment and adaptable
Ability to travel

Nice To Haves

In-depth understanding of medical terminology, healthcare delivery systems, insurance contracts, and legal principles
Proven ability to manage teams, drive results in a matrix environment, and manage change
Strong ability to leverage data analytics for decision-making and identifying risk trends
Highly experienced with all facets of client relations
Excellent written/verbal communication and presentation skills, and the ability to both disseminate a vision at the highest level and understand the details
Excellent people management skills
Ability to successfully manage multiple projects and clients simultaneously
Ability to work independently
Demonstrated problem solving ability
Strong attention to detail

Responsibilities

Develop long-term plan for the Medical Business Unit program claims organization.
Establish and monitor benchmarks and metrics for effective oversight and team performance.
Develop and provide innovative solutions that provide strategic impact to the division and deliver on approved strategic roadmap initiatives.
Cultivate and maintain excellent relationships with reinsurers, business units and client partners.
Establish, negotiate and maintain vendor relationships and contracts.
Collaborate with management team on planning, staffing and budgeting.
Manage audit process that integrates meaningful quality standards, validates appropriate controls and provides value to the division and client partners.
Work with vertical partners to ensure alignment with divisional objectives and standards.
Manage assignment of work/division of responsibilities to ensure that client needs are being met and response times managed to standards.
Provide directions to staff on litigated, complex and potential high exposure claims.
Prepare detailed reports summarizing results of risk management reviews of specific clients.
Prepare portfolio analysis summary reports for delivery to management in Operations and the Business Unit monthly.
Partner with Analytics to identify persistent claims error trends and report those trends regularly to management.
Partner with IT team to innovate, test and implement technology solutions that improve efficiency and productivity of the claims team.
Ensure that all Claims administrators are informed of and in adherence to applicable state unfair claims practices laws.
Work with Claims Account Management team to ensure that all customer interactions are documented using appropriate tools with strict adherence to confidentiality agreements, policies and procedures.
Work with Claims Account Management team, Direct team and verticals to ensure that the process to monitor claim denials Is consistent across the division and being handled within guidelines, consistent with policy provisions and clearly, professionally and courteously communicated to the certificate/policyholder.
Provide the leadership necessary to maintain a motivated, productive and competent team through open communication and delegation of responsibilities and authority.
Be a team leader and builder who has an eye for talent with the ability to maximize resources and capability to deliver business results.
Demonstrate strong mentoring, relationship-building, planning and organizational skills.
Guide and direct team members in their personal and professional development.
Drive performance excellence through goal setting, quality feedback, and performance appraisals within the team (midyear and annual).
Create a working environment where productivity can be sustained and accomplished, and where innovation and personal growth is encouraged and realized.
Drive and role model the A&H culture, values and C&F core competencies within their teams.
Other duties and/or projects as assigned.

Benefits

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
Tuition reimbursement
Industry-related certifications
Professional training
A dynamic, ambitious, fun and exciting work environment
Matching donation program
Volunteer opportunities
Employee-driven corporate giving program