[Hiring] AVP or VP MBU Claims Leader @Crum & Forster

Role Description

The successful candidate will work as part of the Operations team to proactively manage a team of claims professionals including the Claims Program Management teams, Training & Development team, and oversight of Stop Loss and Travel vertical operations. This candidate will be tasked with implementing and managing a long-term strategy that aligns to the division’s objectives.

• Develop long-term plan for the Medical Business Unit program claims organization as the division continues its growth path
• 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 that have a direct impact on divisional results
• 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; on an ongoing basis monitor that alignment
• 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 as needed but no less often than monthly
• 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

Qualifications

• 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

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
• Advanced knowledge in Microsoft Office tools – Outlook, Excel, Word and PowerPoint
• Ability to work in a fast-paced environment and adaptable
• Ability to travel

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, focused on whole family’s wellness
• Tuition reimbursement, industry-related certifications and professional training
• A dynamic, ambitious, fun and exciting work environment
• Spirit of social and community responsibility, matching donation program, volunteer opportunities, and employee-driven corporate giving program