Clinical Operations Specialist, Medical Stop Loss - Remote

Crum & Forster • Phoenix, AZ

22h • Remote

About The Position

Crum & Forster (C&F), with a proud history dating to 1822, provides specialty and standard commercial lines insurance products. C&F has an "A+" (Superior) financial strength rating by AM Best and is recognized for superior customer service and industry-leading claims and risk engineering services. The company values its over 2000 employees across the U.S. and has received workplace and wellness awards, including the 2025 Great Place to Work® Award, emphasizing its employee-first focus and commitment to diversity, equity, and inclusion. C&F is part of Fairfax Financial Holdings, a global, billion-dollar organization. Since 2000, Crum & Forster’s Accident & Health (A&H) division has offered a diverse portfolio of specialty insurance and reinsurance products nationwide, focusing on product development, creative distribution, and excellent client service. A&H also operates internationally through partnerships, providing broader underwriting flexibility. The A&H MBU designs and services products for Employer Stop Loss & Excess Medical, and Ancillary, Life & Supplemental benefits, with a diversified business model including program partnerships and direct sales. 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 within the Medical Business Unit. This role supports Crum and Forster’s vision of being recognized as an industry leader in risk management services and involves supporting team leadership, project management, and other assigned responsibilities.

Requirements

• Bachelor’s degree from an accredited college or university required
• Advanced PC skills include Excel, Word, Outlook, SharePoint/OneDrive storage, etc.
• Ability to demonstrate a high level of customer service delivery, do what is necessary to ensure customer satisfaction
• Ability to acutely prioritize and reprioritize workload as needed throughout the day when referral volume is high
• Focus on accuracy when completing all projects
• Provide a sustained effort and dedication to getting the job done well, works continuously to produce superior work regardless of obstacles or setbacks
• Display personal concern, interest, pride and accountability in all areas of responsibility
• Ability to work both independently and in a team environment
• Strong organization, critical thinking and time management skills with exceptional attention to detail
• Ability to clearly present information through the spoken or written word; read and interpret complex information with moderate supervision
• Quick learner with the willingness and ability to acquire new skills

Nice To Haves

• Employer Stop Loss Claims/notification experience preferred
• Experience with medical terminology and claim coding preferred

Responsibilities

• 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

Benefits

• 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 programs are focused on your whole family’s wellness, including your physical, mental and financial wellbeing
• A 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 path
• A dynamic, ambitious, fun and exciting work environment
• We 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 community

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees