Director, Medical Stop Loss Underwriting

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" (Excellent) 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 2024 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, Life, and Ancillary and Supplemental benefits. Our diversified business model includes program partnerships in Employer Stop Loss as well as direct sales facilitated by our C&F Stop Loss team. At year-end 2022, the MBU recorded $687M in gross premium written.

Job Description

The Accident & Health division is looking for a multi-talented individual to join our team in Clinical Risk Management. The Director, Medical Underwriting role utilizes a high level of experience and advanced knowledge regarding medical conditions, risk and prognoses as it relates to treatment plans and utilization of care in order to provide accurate projected risk (laser) or procedure related lasers for upcoming plan year, and lead a high functioning, responsive team that is responsible for providing high quality medical reviews and recommendations to underwriters and leadership.

What you will do:• Create and maintain processes and documentation to ensure medical underwriting reviews are completed in a timely, thorough, and accurate manner• Manage, develop, and educate a high functioning, responsive team of individuals who are responsible for quantifying known and anticipating unknown clinical risk• Manage relationships with vendors used to assist with timely medical underwriting reviews• Assess and implement emerging technologies and AI utilized to accurately assess and project risk when large amounts of complex data and information are provided• Remain informed and educated on emerging therapies, technologies, medical conditions, and industry changes, and disseminate information to internal and external stakeholders• Ensure effective risk management by consulting with internal and external clients on high cost claims and successfully engaging in effective clinical risk management strategies• Maintain consistent documentation to ensure there is accurate reporting and analysis of referral volume and accuracy/adequacy of lasers• Assist underwriters in the evaluation and assessment of clinical and claims data to identify and quantify known and potential risk• Provide accurate and thorough data scrubbing of reporting provided for risk assessments• Serve as the primary point of contact for all inquiries and day-to-day questions from internal and external stakeholders (underwriters, clients, consultants, sales, stop loss carriers, Programs and TPAs)• Provide concise, detailed and accurate reporting of data analysis findings, observations and recommendations to underwriting• Effectively explain complex clinical conditions to a lay person• Develop and maintain strong client, TPA and vendor relationships • Support timely and accurate intake, triaging, tracking and documentation of potential/actual claims• Quickly, thoroughly and correctly assess a potential/actual claim situation, determine need to impact, develop a sound strategy and successfully influence stakeholders to pro