Crum & Forster logo
Crum & Forster

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. 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. C&F is part of Fairfax Financial Holdings, a global, billion dollar organization.

Clinical Risk Manager, Cost Containment, C&F Stop Loss

RiskRiskFull TimeRemoteSeniorTeam 1,001-5,000H1B No SponsorCompany SiteLinkedIn

Location

New Jersey

Posted

6 days ago

Salary

$64.7K - $147.1K / year

Seniority

Senior

Bachelor Degree5 yrs expEnglish

Job Description

• Support the development and implementation of clinical risk management strategies for high-cost, complex claims. • Analyze incoming cost containment referrals, evaluate clinical and claims data to identify and quantify risk, and engage effective cost containment strategies. • Act as a strategic partner to underwriting by applying evidence-based criteria and sound clinical judgment. • Develop, maintain, and manage strong relationships with internal and external clients, Third-Party Administrators (TPAs), brokers and vendors. • Ensure accurate entry, validation, and analysis of cost containment, notification, and medical underwriting data within the claims system. • Serve as a primary subject matter expert, articulating complex clinical conditions, pharmaceuticals, and risk structures to diverse audiences.

Job Requirements

  • 6-10 years clinical experience with a current unrestricted licensure as a health professional (Registered Nurse)
  • 6+ years of reinsurance or insurance industry experience required
  • Bachelor’s degree from an accredited university or equivalent experience required
  • 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

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.
  • Programs focused on your whole family’s wellness, including physical, mental and financial wellbeing
  • Tuition reimbursement, industry-related certifications and professional training

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