Clinical Operations Specialist, Medical Stop Loss - Remote

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    "url": "https://careers-cfins.icims.com/jobs/4888/clinical-operations-specialist%2c-medical-stop-loss---remote/job",
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    "title": "Clinical Operations Specialist, Medical Stop Loss - Remote",
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    "datePosted": "2024-06-22T08:13:55.003Z",
    "description": "<h2>Crum & Forster Company Overview</h2>\n<p>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. </p>\n<p>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. </p>\n<p>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.</p>\n<p> </p>\n<p>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.</p>\n<p> </p>\n<p>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. </p>\n<p> </p>\n<p>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.</p>\n<p> </p>\n<p>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.</p>\n<h2>Job Description</h2>\n<p>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.</p>\n<p> </p>\n<p>Strong preference for candidates located in Arizona or willing to work Arizona Standard Time schedule.</p>\n<p> </p>\n<p>What you will do for C&F:</p>\n<p> </p>\n<ul>\n <li>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</li>\n <li>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</li>\n <li>Remains compliant with all company and department policies and procedures and service level agreement standards</li>\n <li>Execute system-based reports for use by management to monitor department-wide activity and performance</li>\n <li>Demonstrates a solid work ethic and maintains a positive attitude</li>\n <li>Collaborate effectively with fellow team members to address incoming work with the utmost efficiency</li>\n <li>Track and assign notices and cost containment referrals to appropriate party or team systematically</li>\n <li>Refer claimants for reserves and cost containment according to department guidelines; recognize more complex issues and request guidance in resolving when needed</li>\n <li>Utilize data manipulation techniques in Excel, PDF, Word, etc. to prepare referral files for clinical review</li>\n <li>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</li>\n <li>Create and generate reports based on business need</li>\n <li>Communicate verbally and in writing of all activities and problems within assigned area of responsibility with team and manager</li>\n <li>Provide excellent customer service/communications by responding in a timely and appropriate manner to all internal and external clients</li>\n <li>Other special projects as required</li>\n</ul>\n<p> </p>\n<p>What you will bring to C&F:</p>\n<ul>\n <li>Bachelor’s degree from an accredited college or university required</li>\n <li>Employer Stop Loss Claims/notification experience preferred </li>\n <li>Advanced PC skills include Excel, Word, Outlook, SharePoint/OneDrive storage, etc. </li>\n <li>Experience with medical terminology and claim coding preferred</li>\n <li>Ability to demonstrate a high level of customer service delivery, do what is necessary to ensure customer satisfaction</li>\n <li>Ability to acutely prioritize and reprioritize workload as needed throughout the day when referral volume is high</li>\n <li>Focus on accuracy when completing all projects</li>\n <li>Provide a sustained effort and dedication to getting the job done well, works continuously to produce superior work regardless of obstacles or setbacks</li>\n <li>Display personal concern, interest, pride and accountability in all areas of responsibility</li>\n <li>Ability to work both independently and in a team environment</li>\n <li>Strong organization, critical thinking and time management skills with exceptional attention to detail</li>\n <li>Ability to clearly present information through the spoken or written word; read and interpret complex information with moderate supervision</li>\n <li>Quick learner with the willingness and ability to acquire new skills</li>\n</ul>\n<h2>What C&F will bring to you</h2>\n<ul>\n <li>Competitive compensation package</li>\n <li>Generous 401K employer match</li>\n <li>Employee Stock Purchase plan with employer matching</li>\n <li>Generous Paid Time Off</li>\n <li>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</li>\n <li>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</li>\n <li>A dynamic, ambitious, fun and exciting work environment</li>\n <li>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</li>\n</ul>\n<p> </p>\n<p> </p>\n<p>At C&F you will BELONG</p>\n<p> </p>\n<p>If you require special accommodations, please let us know. 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 accommodations, please let us know</p>\n<p> </p>\n<p> 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.</p>\n<p> </p>\n<p>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 $46,000.00 to a maximum of $86,500.00. 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.</p>\n<p> </p>\n<p>#LI-AV1</p>\n<p>#LI-Remote</p>",
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    "responsibilities": "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.\r\n \r\nStrong preference for candidates located in Arizona or willing to work Arizona Standard Time schedule.\r\n \r\nWhat you will do for C&F:\r\n \r\n- 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\r\n- 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\r\n- Remains compliant with all company and department policies and procedures and service level agreement standards\r\n- Execute system-based reports for use by management to monitor department-wide activity and performance\r\n- Demonstrates a solid work ethic and maintains a positive attitude\r\n- Collaborate effectively with fellow team members to address incoming work with the utmost efficiency\r\n- Track and assign notices and cost containment referrals to appropriate party or team systematically\r\n- Refer claimants for reserves and cost containment according to department guidelines; recognize more complex issues and request guidance in resolving when needed\r\n- Utilize data manipulation techniques in Excel, PDF, Word, etc. to prepare referral files for clinical review\r\n- 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\r\n- Create and generate reports based on business need\r\n- Communicate verbally and in writing of all activities and problems within assigned area of responsibility with team and manager\r\n- Provide excellent customer service/communications by responding in a timely and appropriate manner to all internal and external clients\r\n- Other special projects as required\r\n \r\nWhat you will bring to C&F:\r\n- Bachelor’s degree from an accredited college or university required\r\n- Employer Stop Loss Claims/notification experience preferred \r\n- Advanced PC skills include Excel, Word, Outlook, SharePoint/OneDrive storage, etc. \r\n- Experience with medical terminology and claim coding preferred\r\n- Ability to demonstrate a high level of customer service delivery, do what is necessary to ensure customer satisfaction\r\n- Ability to acutely prioritize and reprioritize workload as needed throughout the day when referral volume is high\r\n- Focus on accuracy when completing all projects\r\n- Provide a sustained effort and dedication to getting the job done well, works continuously to produce superior work regardless of obstacles or setbacks\r\n- Display personal concern, interest, pride and accountability in all areas of responsibility\r\n- Ability to work both independently and in a team environment\r\n- Strong organization, critical thinking and time management skills with exceptional attention to detail\r\n- Ability to clearly present information through the spoken or written word; read and interpret complex information with moderate supervision\r\n- Quick learner with the willingness and ability to acquire new skills",
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