Director, Medical Underwriting, C&F Stop Loss

Crum & Forster • Eatontown, NJ

11d • $95,600 - $179,600 • Remote

About The Position

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 clinical expertise regarding nursing, insurance, medicine, stop loss insurance, reinsurance, claims, medical underwriting, and/or underwriting to direct a team responsible for delivering accurate and timely cost projections and savings opportunities to C&F.

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 Medical Business Unit (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 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 over $1B in gross premium written.

Requirements

• Bachelor's degree from an Accredited college or university or equivalent
• 10 years clinical experience with a current unrestricted licensure as a health professional (Registered Nurse), as well as 5-10 years of Stop Loss or Reinsurance experience required
• 10+ years of case/claim management experience
• Strong PC skills including Excel, Word, Outlook
• Group medical, managed care, health insurance, stop loss or reinsurance experience required
• Strong knowledge of disease processes and treatment plans
• 2+ years management experience preferred
• Demonstrated success in a leadership/management role to drive and deliver outcomes

Nice To Haves

• A high level of service delivery in efforts to do what is necessary to ensure customer satisfaction
• Ability to establish a good rapport with all customers and internal team members/staff
• Ability to analyze relevant aspects of a situation before reaching a conclusion, with no hesitation in taking action when required
• Sustained effort and dedication to getting the job done well, working continuously to produce superior work regardless of obstacles or setbacks
• Display personal concern, interest, pride and accountability in all areas of responsibility
• Demonstrate a solid work ethic and maintain a positive attitude
• Ability to work both independently and in a team environment
• Excellent organization and time management skills with exceptional attention to detail
• Ability to effectively handle multiple tasks, adapt to change and work in a fast-paced environment
• A quick learner with the willingness and ability to acquire new skills
• Intermediate level of investigative, analytical and problem-solving skills
• Expert negotiating, persuasion and conflict resolution skills
• Excellent oral, written and interpersonal communication skills
• 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 reports (i.e. trigger reports, pended claims reports, pre-cert reports, case management reports, RX reports, etc.) to determine degree of risk
• Demonstrated success in a leadership and service/consultative role
• A focus on accuracy when completing all projects

Responsibilities

• Day-to-day management, leadership, support, and guidance for the Medical Underwriting team
• Create and maintain processes and documentation to ensure medical underwriting reviews are completed in a timely, thorough, and accurate manner; ensure effective risk management by evaluating and assessing clinical and claims data to identify and quantify known and potential risk
• Provide accurate and thorough data scrubbing of reporting provided for underwriting reviews, using advanced tools developed via AI or the Digital Transformation team to quantify known and potential risk
• Act as a strategic partner to underwriting, directing the evaluation of complex clinical and claims data to accurately identify, quantify, and advise on significant risks, influencing underwriting strategy and decisions at a claimant, case, and block level
• Remain informed and educated on emerging therapies, technologies, medical conditions, and industry changes, and disseminate information to internal and external stakeholders; facilitate and drive education of internal and external stakeholders
• Strategically oversee and facilitate exploration of new methods and processes including AI to increase efficiency and attain achievement of both individual and organizational goals; provide direction and framework for more junior staff
• Consult with internal and external clients on high-cost claims and successfully direct appropriate medical underwriting activity; provide mentorship with expert judgment to determine optimal referral pathways to appropriate clinical risk team members and junior staff
• Manage, develop, and educate a high functioning, responsive team of individuals who are responsible for quantifying known and anticipating future clinical risk
• Provide concise, detailed and accurate assessments, projections, observations and recommendations and effectively explain complex cost containment scenarios to a lay person, TPA, broker, or executive leadership
• Validate or refute appropriateness of stop loss claims costs and provide leadership and direction for effective risk management
• Serve as a primary subject matter expert, adeptly articulating highly complex clinical conditions, pharmaceuticals, and risk structures to diverse audiences, including executive leadership, employing influential communication strategies to drive understanding and consensus
• Provide strategic leadership and direction in establishing and upholding best-in-class standards for customer service and communications across the organization; develop, implement, and continuously refine policies and protocols to ensure all internal and external client inquiries are addressed promptly, professionally, and in alignment with organizational objectives
• Mentor and empower teams to deliver exceptional service, proactively identify opportunities for service improvement, and drive a culture of excellence in client engagement at all levels
• Oversee accurate entry, validation, and comprehensive analysis of medical underwriting data within the claims system, maintaining the highest standards of data integrity and compliance
• Proactively identify, investigate, and resolve process gaps or data inconsistencies, leveraging advanced analytical skills and industry knowledge to recommend and drive process improvements
• Collaborate with cross-functional teams - including underwriting, claims and IT - to streamline data workflows, enhance system functionality, and support strategic business objectives
• Prepare and present detailed reports on data trends, process gaps, and improvement initiatives to management, supporting informed decision-making and continuous operational enhancement
• Keep manager informed verbally and/or in writing as appropriate of activities and problems within Medical Underwriting team
• Remain compliant with all company and department policies, procedures, and service standards.
• Document activity and outcomes accurately and promptly
• Build a high-performance culture by developing the team's cross-functional skills
• Assist in managing the overall morale and culture of the department
• Facilitate recurring 1:1's with all direct reports
• Other duties as assigned

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.
• Wellness programs focus on your family’s complete wellness, including your physical and mental wellbeing
• Tuition reimbursement
• Industry related certifications
• Professional training available

What This Job Offers

• Job Type: Full-time
• Career Level: Manager