Job Closed
This listing is no longer active.
Crum & Forster (C&F) provides market leading property & casualty, accident & health, specialty and standard commercial lines insurance solutions. A true underwriting company, we have a 200-year history of helping our customers manage risk with laser-focused expertise, integrity, and discipline. Our people are empowered to make decisions and problem-solve smartly and swiftly. Our annual gross written premium is 6.2 billion. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best. Our most valuable asset is our people. We have 3000 employees, and locations throughout the United States and India. With our employee-first focus, the Company is consistently recognized as a great place to work, earning multiple workplace and wellness awards, including the Great Place to Work® Award, Fortune 100 Best Companies to Work For, Fortune Best Workplaces for Parents, Fortune Best Workplaces for Millennials, and many others. C&F is part of Fairfax Financial Holdings. For more information about C&F, please visit our website: www.cfins.com .
Senior Claims Examiner
Location
United States
Posted
77 days ago
Salary
$67.9K - $127.6K / year
Seniority
Senior
No structured requirement data.
Job Description
Senior Claims Examiner
Crum & Forster
Role Description Seneca is looking for a senior claims specialist who enjoys being a key part of a dynamic team. As a Senior Claims Examiner, you will manage an assigned pending of claims arising from insurance policies, primarily Commercial General Liability with mid-to-high level of risk and complexity. You will also be expected to operate under appropriate levels of supervision and within established authority. The position will report to assigned Manager, AVP or Vice President, as determined by business needs. This position can be in one of our offices in New York, NY, Jersey City, NJ, Morristown, NJ, or Alpharetta, GA, with flexible work options available. Remote locations will also be considered for the right candidate. What you will do for C&F: - Receives claims assignments. Verifies and determines applicability of coverage. - Determines the method and extent of investigation for each claim as required by company Best Practices. - Reviews and manages outstanding files, as assigned, for adequacy and timeliness of investigation, evaluation and reserve and maintains a timely diary for each case. - Evaluates and adjusts claims within the adjuster’s authority level. - Reports directly on technical matters to supervisor or management. - Evaluates and manages litigated claims, determines future course of handling and proper method of disposition. Consults with the claim manager on those claims in which assistance and consultation is needed, as well as on those claims which exceed assigned authority. - Assesses recovery potential and is responsible for the development of information required to successfully pursue recovery. - Meets with current and prospective customers to discuss Seneca claims capabilities and address specific claim needs. - Accountable for the equitable and prompt adjustment and management of assigned claims to disposition in accordance with company Best Practices. - Responsible for providing superior customer service to all agents, insureds, and others encountered during the claims handling process. - Understanding/knowledge of contractual indemnity and additional insured risk transfer opportunities preferred. Qualifications - Bachelor’s degree or equivalent and 6+ years’ experience handling general liability claims, including New York Labor Law and catastrophic bodily injury claims, with some experience managing coverage-related matters filed by or against the insurer. - Designation and/or insurance related courses are a plus. - Obtain and maintain required state licenses. - Excellent verbal and written communication skills are essential and the ability to communicate with all levels within the organization. - Computer skills with a working knowledge of the Microsoft Office suite of programs a must. - Travel occasionally required. 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 - 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
Related Guides
Related Categories
Related Job Pages
More Claims Specialist Jobs
• Managing all aspects of litigated cases, including evaluation of the resolution process • Analyze auto claims to identify areas of dispute, investigating and gathering all necessary information and documentation, evaluating liability and damages and negotiating and resolving claims with opposing parties or their insurance providers • Manage litigation cases related to auto claims disputes, communicating regularly with clients, attorneys, vendors and other stakeholders • Review legal documents and ensuring compliance with initial suit-handling plan of action. • Analyze policy language and reaching appropriate coverage decisions. • Direct and control the activities and costs of outside vendors including defense counsel and coverage counsel, experts and independent adjusters • Maintain the appropriate adjuster licenses and continuing education requirements
Role Description The Claims Adjudicator II position will receive, examine, verify and input submitted claim data, determine eligibility status, and review and adjudicate claims within established timeframes. This position utilizes multiple systems in order to perform the day-to-day functions of processing medical, disability, vision and dental claims, as well as, provider and member driven inquiries. - Screens claims for completeness of necessary information - Verifies participant/dependent eligibility - Interprets the plan benefits from the Summary Plan Description (SPD)/Plan Documents - Codes basic information and selects codes to determine payment liability amount - Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation in relation to benefit requirements, accuracy of the claim filed, and the appropriateness or frequency of care rendered - Determines the need for additional information or documentation from participants, employers, providers and other insurance carriers - Handles the end to end process of Medicare Secondary Payer (MSP) files - Processes Personal Injury Protection (PIP) claims - Requests overpayment refunds, maintains corresponding files and performs follow-up actions - Handles verbal and written inquiries received from internal and external customers - Processes Short Term Disability claims - Adjudicates claims according to established productivity and quality goals - Achieve individual established goals in order to meet or exceed departmental metrics Qualifications - 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment - Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits - Experience with eligibility verification, medical coding, coordination of benefits, and subrogation and its related processes - Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes - Fluency (speak and write) in Spanish, preferred Requirements - Salary range for this position: Hourly $20.36 - $24.97 - Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location. - Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) Fully Remote, after 1-week training onsite in Oak Brook, IL. (Travel and Lodging paid for by UHH) Benefits - Medical - Dental - Vision - Paid Time-Off (PTO) - Paid Holidays - 401(k) - Pension - Short- & Long-term Disability - Life - AD&D - Flexible Spending Accounts (healthcare & dependent care) - Commuter Transit - Tuition Assistance - Employee Assistance Program (EAP)
Claims Team Lead
ReservAt Reserv, we value diversity in backgrounds, perspectives, and life experiences and believe that diversity in viewpoints and critical thinking drives innovation, first-principles thinking, and success. We welcome applicants from all backgrounds and encourage those from all walks of life to apply. If you believe you are a good fit for this role, we would love to hear from you!
Role Description As a Claims team leader at Reserv, you will be responsible for a team of claims professionals managing claims in your experienced line of business. We want your background and experience to deliver operational effectiveness, particularly in leveraging technology and analytics to drive better efficiencies and performance. You will serve a critical role with the team, the customers, and the client. The high-performing team you will manage will service several clients as part of our Core Team. You will maintain high quality standards, and compliance with regulatory, internal, and external contractual SLAs. This position requires exceptional leadership skills, and a foundational understanding of claims with experience handling and managing a team of individuals. Qualifications - Highly motivated and growth-oriented - Subject matter expert in commercial claims, including coverage and litigation - Tech-oriented with proven results leveraging technology and analytics - Passionate claims professional who cares about their team and customer experience - Empathetic leader promoting the ‘Reserv Way’ and values - Sense of urgency without working at all hours - Creative in challenging existing assumptions and leveraging technology - Curious and decisive in making informed decisions - Problem solver focused on operational workings while keeping the big picture in mind - Anti-status quo, taking action to improve processes - Communicative and comfortable with phone communications throughout the claims process - Possesses a sense of humour Requirements - Chartered Institute Qualifications minimum of DIP CII or equivalent - 10+ years in insurance claims management experience in multiple lines of business - 5+ years of management experience, preferably in a remote environment - Comfortable with technology to evolve claims systems and processes - Demonstrated commitment to quality, accuracy, and attention to detail - Integrity, ethics, and accountability in handling confidential information Benefits - Generous health-insurance package with nationwide coverage, vision, & dental - 401(k) retirement plan with employer matching - Competitive PTO policy for employee well-being - Generous family leave policy after 8 months of continuous work - Work from anywhere to facilitate work-life balance - Apple laptop, large second monitor, and other quality-of-life equipment - Listen to your feedback to enhance the adjuster role - Work toward reducing administrative work from the adjuster role - Foster a culture of empathy, transparency, and empowerment in a remote-first environment
Claims Support and Administrative Coordinator
Dream Finders HomesJET Homeloans is an Equal Employment Opportunity/Affirmative Action Employer and maintains a Drug-Free Workplace. NOTE: This job description is not intended to be all-inclusive. Employee may perform other related duties as negotiated to meet the ongoing needs of the organization.
Role Description The Claims Support and Administrative Coordinator is responsible for supporting the claims team. The individual assists claimants, responds to inquiries, provides administrative support on claim files, prepares reports, and provides data and information to other departments, and manages a small caseload of title clearance matter files to a final resolution with supervisor oversight. Essential Duties and Responsibilities - Facilitate initial communication between claims and claimants. - Notify active agents of any new claims received unless there are extenuating circumstances. - Responsible for sending acknowledgement letters to appropriate parties. - Create monthly, or as needed, claim reports. - Provide legal research support to claims team when applicable. - Assist claims in conducting legal research to assist in case preparation. - Assist with drafting department policies and procedures. - Organize and maintain file system, correspondence, legal research, and other records. - Assist with requested claim audits. - Ensure deadlines are met. - Attend a conference, training session, or webinar related to the title industry to stay current. - Conduct thorough investigation on assigned low to medium difficulty level claim files, gather data, analysis of title policy and other products, and provide a recommendation for the best resolution for the claim. - Communicate with agent, if appropriate, of any sizeable loss to be paid on a file. - Examine title and develop strategy for resolution of claim in most cost-effective manner. - Determine need to retain defense counsel to defend the company or its insured in litigation and engage outside counsel with required approvals. - Evaluate liability and establish recommendations for settlement and expense reserves. - Resolve claims that do not require the defense of the company or that are covered claims through investigation, corrective documents, negotiation, or payment. - Draft agreements and corrective documents for review and approval by appropriate senior manager or, if appropriate, Claims Management Committee. - Review and approve invoices for costs and attorneys' fees. - Evaluate claims for recoupment options. - Review files assigned as part of company reserve process and update financial reserves accordingly. - Draft educational and training materials for seminars and present at seminars. - Support team to educate and train agents on claim concerns and how to avoid claim issues. Competencies - Achievement Focus: Demonstrates persistence and ability to overcome obstacles. Measures self against standard of excellence. Recognizes and acts on opportunities. Sets and achieves challenging goals. Takes calculated risks to accomplish goals. - Communications: Exhibits good listening and comprehension skills. Expresses ideas and thoughts in written and verbal form. Keeps others adequately informed. Selects and uses appropriate communication methods. - Managing Customer Focus: Develops new approaches to meeting customer needs. Establishes customer service standards. Monitors customer satisfaction. Promotes customer focus. Always calm and respectful in difficult situations. - Planning and Organization: Integrates changes smoothly. Plans for additional resources. Prioritizes and plans work activities. Sets goals and objectives. Uses time efficiently. Works in an independent and organized manner. - Problem Solving: Develops alternative solutions. Gathers and analyzes information skillfully. Identifies problems in a timely manner. Resolves problems in early stages. Works well in group problem solving situations. Decisive and accountable. Qualifications - Paralegal with one to three years related experience and/or training in title insurance or real estate industry preferred. - Read, analyze and interpret business, professional, technical or governmental documents. - Write reports, business correspondence and procedure manuals. - Effectively present information and respond to questions from managers, customers and the public. - Solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. - Highly proficient in Microsoft Suite and internet research. - Paralegal certification. Supervisory Responsibilities This job has no supervisory responsibilities. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the workplace is typically moderate. This position is a remote position. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - While performing the duties of this job, the employee is regularly required to sit. - The employee is frequently required to use hands to finger, handle, or feel and talk or hear. - The employee is occasionally required to stand and walk. - The employee must be able to occasionally lift and/or move up to 10 pounds. - Specific vision abilities required by this job include close vision.


