Clinical Operations Specialist, Medical Stop Loss - Remote

Crum & Forster Company Overview

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.

Job Description

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 underwriting
• Accurate 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 SaaS
• Remains compliant with all company and department policies and procedures and service level agreement standards
• Execute system-based reports for use by management to monitor department-wide activity and performance
• Demonstrates a solid work ethic and maintains a positive attitude
• Collaborate effectively with fellow team members to address incoming work with the utmost efficiency
• Track and assign notices and cost containment referrals to appropriate party or team systematically
• Refer claimants for reserves and cost containment according to department guidelines; recognize more complex issues and request guidance in resolving when needed
• Utilize data manipulation techniques in Excel, PDF, Word, etc. to prepare referral files for clinical review
• Stay 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 responsibilities
• Create and generate reports based on business need
• Communicate verbally and in writing of all activities and problems within assigned area of responsibility with team and manager
• Provide excellent customer service/communications by responding in a timely and appropriate manner to all internal and external clients
• Other special projects as required

 

What you will bring to C&F:

• Bachelor’s degree from an accredited college or university required
• Employer Stop Loss Claims/notification experience preferred
• Advanced PC skills include Excel, Word, Outlook, SharePoint/OneDrive storage, etc.