Clinical Risk Manager, C&F Stop Loss

Crum & Forster Company Overview

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 with you 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

Job Description

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, 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 $1B in gross premium written.

 

Information about the Role, Line of Business and Team:

The Clinical Risk Manager role utilizes a high level of experience and advanced knowledge regarding nursing, medical conditions, risk and prognoses as it relates to treatment plans and utilization of care. The Clinical Risk Manager provides accurate current and next year cost projections and savings opportunities to C&F.

 

What you will do:

Medical Risk Assessment & Clinical Evaluation

• Review and analyze all data and documentation within existing systems and that provided by Underwriting including but not limited to diagnoses, procedures, case management notes, treatment plans, and comorbid conditions to assess validity of data and clinical risk.
• Identify clinical factors that may impact underwriting outcomes or financial exposure at a claimant and population health level for Underwriters to leverage in their rating of the group.
• Exercise independent clinical judgment to synthesize complex medical information into clear risk conclusions that support sound underwriting decisions.
• Support the development and implementation of clinical risk management strategies for high-cost, complex claims through strategic identification of cost-containment opportunities while reviewing all available data for MUW review.
• Cross-refer to cost containment when appropriate and participate in cost containment work as requested.

Strategic Underwriting Partnership

• Triage and prioritize requests for medical underwriting review based on business urgency, workload capacity, and alignment with underwriting and leadership priorities

• Act as a strategic partner to underwriting by applying evidence-based criteria and sound clinical judgment to evaluate complex clinical and claims data to identify, quantify, and advise on significant risks, directly influencing underwriting strategy and decisions.

Client & Stakeholder Management

• Develop, maintain, and manage strong relationships with internal and external clients, Third-Party Administrators (TPAs), and vendors, championing exemplary customer service standards.
• Consult with clients and teams on submitted data for MUW, program development, quality improvement, and claim issues.
• Act as a point of contact for escalations and participate in calls with internal and external clients a