Crum & Forster · 1 day ago

Claims Examiner- Employer Stop Loss-Remote

Eatontown, NJ

Full-time

Remote

Mid Level

$46K/yr - $86K/yr

3+ years exp

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Responsibilities

Review all claim submissions for completeness, accuracy, and conformance to the Plan Document, SPD, and Policy

Communicate all necessary follow-up with TPAs and other parties

Confirm appropriate disclosure when applicable

Calculate and maintain reserves as needed

Communicate all payment or denial decisions in a clear and professional manner

Monitor Aggregate Accommodation activity and review aggregate claim submissions

In conjunction with the Claim Manager, develop and enhance claim procedures to communicate to TPAs for Employer Stop Loss business (ESL)

Maintain appropriate reporting and communication with team and management regarding your assigned areas of responsibility

Other duties as assigned

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Claim experienceEmployer Stop Loss (ESL) claimsMicrosoft Office SuiteDYS softwareProcess improvement