Director, Medical Stop Loss Underwriting
Apply NowCompany: Crum & Forster
Location: Eatontown, NJ 07724
Description:
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 produce a meaningful clinical &/or financial outcome
Other projects or duties as assigned
What YOU will bring to C&F:
Ability to establish a good rapport with all stakeholders
Ability to prioritize and manage multiple competing tasks in a fast paced, innovative environment
Professional curiosity surrounding technology and AI-related programs and processes
Demonstration of a high level of service delivery and the ability to do what is necessary to ensure customer satisfaction, while dealing with service failures and prioritizing customer needs
Analyze relevant aspects of a situation before reaching a conclusion, while taking action when required
Capacity to explore, develop and implement new methods and processes, which increases efficiency and effectiveness to attain achievement of both individual and organizational goals
A focus on accuracy when completing all projects
A sustained effort and dedication to getting the job done well and working continuously to produce superior work, regardless of obstacles or setbacks
Ability to display personal concern, interest, pride and accountability in all areas of responsibility
Strong organization and time management skills with exceptional attention to detail
Expert negotiating, persuasion and conflict resolution skills
Ability to work both independently and in a team environment
Able to clearly present information through the spoken or written word, read and interpret complex information
Ability to read and research medical history reports while utilizing multiple resources and applying judgement in determining the final decision with appropriate supportive documentation
Ability to examine and interpret insurance reports (i.e. trigger reports, pended claims reports, pre-cert reports, case management reports, RX reports, etc.) to determine degree of risk
Requirements:
Requires 10 years clinical experience with a current unrestricted licensure as a health professional (Registered Nurse)
Bachelor's Degree in a related field preferred
5+ years of stop loss / reinsurance experience required
5+ years of supervisory experience preferred
Group medical, managed care, health insurance, stop loss or reinsurance experience
Strong knowledge of disease processes and treatment plans
Demonstrated success in a service/consultative role
Strong PC skills including Excel, Word, Outlook, Power Point, AI
Proficiency in Stop Loss Office/David Young ESL system
What C&F will bring to you
At C&F you will BELONG
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 accommodation, please let us know.
For 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 $95,600 to a maximum of $179,600. 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.
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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 produce a meaningful clinical &/or financial outcome
Other projects or duties as assigned
What YOU will bring to C&F:
Ability to establish a good rapport with all stakeholders
Ability to prioritize and manage multiple competing tasks in a fast paced, innovative environment
Professional curiosity surrounding technology and AI-related programs and processes
Demonstration of a high level of service delivery and the ability to do what is necessary to ensure customer satisfaction, while dealing with service failures and prioritizing customer needs
Analyze relevant aspects of a situation before reaching a conclusion, while taking action when required
Capacity to explore, develop and implement new methods and processes, which increases efficiency and effectiveness to attain achievement of both individual and organizational goals
A focus on accuracy when completing all projects
A sustained effort and dedication to getting the job done well and working continuously to produce superior work, regardless of obstacles or setbacks
Ability to display personal concern, interest, pride and accountability in all areas of responsibility
Strong organization and time management skills with exceptional attention to detail
Expert negotiating, persuasion and conflict resolution skills
Ability to work both independently and in a team environment
Able to clearly present information through the spoken or written word, read and interpret complex information
Ability to read and research medical history reports while utilizing multiple resources and applying judgement in determining the final decision with appropriate supportive documentation
Ability to examine and interpret insurance reports (i.e. trigger reports, pended claims reports, pre-cert reports, case management reports, RX reports, etc.) to determine degree of risk
Requirements:
Requires 10 years clinical experience with a current unrestricted licensure as a health professional (Registered Nurse)
Bachelor's Degree in a related field preferred
5+ years of stop loss / reinsurance experience required
5+ years of supervisory experience preferred
Group medical, managed care, health insurance, stop loss or reinsurance experience
Strong knowledge of disease processes and treatment plans
Demonstrated success in a service/consultative role
Strong PC skills including Excel, Word, Outlook, Power Point, AI
Proficiency in Stop Loss Office/David Young ESL system
What C&F will bring to you
At C&F you will BELONG
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 accommodation, please let us know.
For 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 $95,600 to a maximum of $179,600. 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.
- Flexible work arrangements.
- Competitive compensation package.
- Generous 401K employer match.
- Employee Stock Purchase plan with employer matching.
- Generous Paid Time Off.
- Excellent benefits that go beyond health, dental & vision. Our Wellness programs focus on your family's complete wellness, including your physical and mental wellbeing
- A core C&F principle is that you manage your career. To support your development, we have a wealth of ways for you to keep learning, including tuition reimbursement, industry related certifications and professional training available to you.
- A dynamic, ambitious, fun and exciting work environment.
- A spirit of social responsibility, matching donation program, volunteer opportunities, and an employee driven corporate giving.
#LI-JA1
#LI-Remote