Clinical Operations Specialist, Medical Stop Loss - ...

Crum & 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.Since 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 Crum & Forster Accident & Health 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; and Ancillary, Life & 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 over $1B in gross premium written.The Clinical Operations Specialist role is an integral part of Crum & Forster Employer Stop Loss which is part of the Medical Business Unit. Our Clinical Operations Specialist supports Crum and Forster’s vision of being recognized as an industry leader in risk management services. This role supports team leadership, project management, and other additional responsibilities as assigned.What you will do for C&F:Receive, Track, Identify and analyze claims data and clinical information as appropriate for the pre-renewal, medical underwriting, and cost containment processes, provide communication and support for clinical review and cost containment teams as well as underwritingAccurate setup of incoming and outgoing referral and review documents, utilizing medical underwriting and cost containment platforms including intake logs, Conexure, Access, Sharepoint, OneDrive, etc. as well as external SaaSRemains compliant with all company and department policies and procedures and service level agreement standardsExecute system-based reports for use by management to monitor department-wide activity and performanceDemonstrates a solid work ethic and maintains a positive attitudeCollaborate effectively with fellow team members to address incoming work with the utmost efficiencyTrack and assign notices and cost containment referrals to appropriate party or team systematicallyRefer claimants for reserves and cost containment according to department guidelines; recognize more complex issues and request guidance in resolving when neededUtilize data manipulation techniques in Excel, PDF, Word, etc. to prepare referral files for clinical reviewStay informed of and participate in key IT system functions and updates currently being utilized for all stop loss programs within the scope of the Clinical Operations Specialist’s responsibilitiesCreate and generate reports based on business needCommunicate verbally and in writing of all activities and problems within assigned area of responsibility with team and managerProvide excellent customer service/communications by responding in a timely and appropriate manner to all internal and external clientsOther special projects as requiredWhat you will bring to C&F:Bachelor’s degree from an accredited college or university requiredEmployer Stop Loss Claims/notification experience preferred Advanced PC skills include Excel, Word, Outlook, SharePoint/OneDrive storage, etc. Experience with medical terminology and claim coding preferredAbility to demonstrate a high level of customer service delivery, do what is necessary to ensure customer satisfactionAbility to acutely prioritize and reprioritize workload as needed throughout the day when referral volume is highFocus on accuracy when completing all projectsProvide a sustained effort and dedication to getting the job done well, works continuously to produce superior work regardless of obstacles or setbacksDisplay personal concern, interest, pride and accountability in all areas of responsibilityAbility to work both independently and in a team environmentStrong organization, critical thinking and time management skills with exceptional attention to detailAbility to clearly present information through the spoken or written word; read and interpret complex information with moderate supervisionQuick learner with the willingness and ability to acquire new skillsCompetitive 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 knowFor 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 $46,000.00 to a maximum of $86,500.00. 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.#LI-AV1#LI-Remote

Created: 2026-04-23