Claims Program Manager

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Contribute to the development of a relationship-focused culture through a wide range of activities, which include managing a varied portfolio of medical products and administrators consistently.

• Act as a “next-step” liaison to the administrative, operations, and underwriting divisions of the company, on an ongoing basis.

• Employ sensitivity techniques to professionally address pertinent issues with distressed customers regularly.

• Participate in meetings with clients alongside team members and resolve all outstanding issues at least quarterly.

• Tackle technical challenges and collaborate with the IT team to seek solutions as necessary.

• Support the Program Management Team in onboarding new clients as required.

• Cultivate long-term customer relationships through timely and courteous service.

• Assist in the due diligence of new program administration businesses, which includes onsite evaluations and assessments, while providing management with an operational assessment of potential partners.

• Conduct annual evaluations of administrators to ensure adherence to company standards while identifying gaps in processes and areas for potential enhancement at both the administrator and company level.

• Monitor claims activity to detect any anomalies at least quarterly.

• Prepare monthly reporting packages, which include, but are not limited to, inventory reports, first level (TPA customer service & turnaround) statistics, and referral analysis (turnaround times, volume breakdowns) for review by VP / AVP / Director and Senior Management.

• Assist in the monthly analysis of all claims related to litigation/regulatory inquiries and/or high-value claims to identify trends and exposures.

• Aid in drafting and maintaining reference documents for internal Claims Best Practices, including: Standards – both C&F and regulatory, Procedures, and Workflow.

⛳️ Requirements

• Bachelor’s Degree from an accredited university or institution.

• Over 6 years of experience in relevant Medical Stop Loss or Medical Excess fields.

• Experience with specialty products such as Employer Stop Loss, Short Term Medical, Medical Excess, Fixed Indemnity, and Life is preferred.

• Proficient in Microsoft Office applications – Outlook, Excel, Word, and PowerPoint.

• Capable of thriving in a fast-paced environment and adaptable to change.

• Willingness to travel up to 40%.

🏝️ Benefits

• Competitive compensation package.

• Generous 401K employer matching.

• Employee Stock Purchase plan with employer matching.

• Ample Paid Time Off.

• Excellent benefits that extend beyond health, dental, and vision.

• Our programs focus on the wellness of your entire family, encompassing physical, mental, and financial wellbeing.

• A core tenet of C&F is taking ownership of your career development, so we offer numerous opportunities for continuous learning, including tuition reimbursement, industry-related certifications, and professional training to support your advancement on your chosen path.

• A dynamic, ambitious, enjoyable, and stimulating work environment.

• We believe in doing well by doing good and encourage a spirit of social and community responsibility, featuring a matching donation program, volunteer opportunities, and an employee-driven corporate giving program that allows you to engage and support your community.