Claims Examiner, Medical Stop Loss

Crum & Forster Company OverviewCrum & 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. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best and is proud of our superior customer service platform. Our claims and risk engineering services are recognized as among the best in the industry. Our most valuable asset is our people: more than 2000 employees in locations throughout the United States. The company is increasingly winning recognition as a great place to work, earning several workplace and wellness awards, including the 2025 Great Place to Work® Award for our employee-first focus and our steadfast commitment to diversity, equity and Inclusion. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization. For more information about Crum & Forster, please visit our website: www.cfins.com.Job DescriptionSince 2000, Crum & Forster’s Accident & Health division (A&H) has offered a diverse portfolio of specialty insurance and reinsurance products nationwide. We place a strong focus on product development and creative distribution methods, along with excellent client service and support.In addition to our robust domestic portfolio, which spans both special risk and medical solutions, A&H works on an international basis through various partnerships. Our global capabilities provide our partners with even broader flexibility in underwriting solutions. The qualities and capabilities of A&H demonstrate our philosophy of building meaningful, long-term partnerships and our dedication to providing alternative strategies in an ever-changing insurance market.The A&H MBU takes a full-spectrum approach to designing and servicing a robust slate of products tailored to needs in Employer Stop Loss, Excess Medical, Life, and Ancillary and Supplemental benefits. Our diversified business model includes program partnerships as well as direct sales in Employer Stop Loss. At year-end 2025, the MBU recorded $1.02 Billion in gross premium written.This is a unique opportunity to work with a high-quality team of leaders and benefit from the security and stability of a large organization while maintaining a nimble and responsive approach to business. The successful candidate will work as part of a team and be responsible for evaluating claim eligibility, outlining claim exposure, processing payments to policyholders, and maintaining appropriate reporting to management. This individual will interact internally with fellow team members and externally with the division’s business partners. The C&F SL team has an objective to write and administer $2 billion in business in the next 5 years. What you will do for C&F:Within documented authority levels, review all claim submissions for accuracy, completeness, and compliance with various Plan Documents, SPDs, and PoliciesClearly and professionally communicate external requests for information and maintain timely follow-upClearly and professionally communicate claim payment and denial decisionsConfirm appropriate disclosure when applicable Calculate and maintain reserves as neededAssist with aggregate accommodation activities and aggregate claim submissionsMaintain appropriate reporting and communication with team and management regarding your assigned areas of responsibilityAssist with refining internal claim procedures and recommending improvements to managementOther duties as assignedWhat you will bring to C&F3+ years medical stop loss claim experience requiredBachelor’s degree or equivalent experience requiredStrong working knowledge of both Microsoft Office suite with an aptitude to learn new programs (ESL Office experience preferred)Ability to establish a good rapport with all stakeholdersCommitment to delivering outstanding customer service and satisfaction Commitment to exploring and assisting in implementing new processes to increase effectiveness and achieve organizational goalsExceptional attention to detail and accuracy Capability to manage multiple priorities in a fast-paced environmentExcellent written and verbal communication skillsWhat C&F will bring to youCompetitive compensation packageGenerous 401K employer matchEmployee Stock Purchase plan with employer matchingGenerous Paid Time OffExcellent benefits that go beyond health, dental & vision. Our programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeingA 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 pathA dynamic, ambitious, fun and exciting work environmentWe 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 communityAt C&F you will BELONGIf you require special accommodations, please let us know. 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 accommodations, please let us know For California Residents Only: Information collected and processed as part of your career profile and any job applications you choose to submit are subject to our privacy notices and policies, visit https://www.cfins.com/onlineprivacypolicy/ca/noticeatcollection/ for more information.Crum & Forster is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws. Salary ranges are available for all positions at this location, taking into account roles with a comparable level of responsibility and impact in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized base pay for the advertised position, located in the specified area, ranges from a minimum of $48,300.00 to a maximum of $90,800.00. The actual compensation is determined by various factors, including but not limited to the market pay for the jobs at each level, the responsibilities and skills required for each job, and the employee’s contribution (performance) in that role. To be considered within market range, a salary is at or above the minimum of the range. You may also have the opportunity to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs.Originally posted on Himalayas