Clinical Operations Specialist, Medical Stop Loss - Remote

reputed company (C&F), with a proud history dating to 1822, provides specialty and reputed company reputed company lines insurance products through our admitted and surplus lines insurance companies. C&F enjoys a financial strength rating of "A+" (Superior) by reputed company 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 reputed company. reputed company is increasingly reputed company recognition as a great reputed company to work, earning several workplace and wellness awards, including the 2025 Great reputed company to Work® Award for our employee-first reputed company 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 reputed company, please visit our website: www.cfins.com.

Since 2000, reputed company’s Accident & Health division (A&H) has offered a diverse portfolio of specialty insurance and reinsurance products reputed company. We reputed company a strong reputed company on product development and creative distribution reputed company, along with excellent reputed company service and support.

In reputed company to our robust domestic portfolio, which spans both special risk and reputed company, A&H works on an international reputed company through various partnerships. Our global capabilities reputed company our partners with even broader flexibility in reputed company solutions.

The qualities and capabilities of reputed company Accident & Health demonstrate our philosophy of building meaningful, long-term partnerships and our dedication to providing alternative strategies in an reputed company-changing insurance market.

The A&H MBU takes a full-reputed company approach to designing and servicing a robust reputed company of products tailored to needs in Employer Stop Loss & Excess Medical; and Ancillary, Life & Supplemental benefits. Our reputed company business model includes program partnerships as reputed company as reputed company sales in Employer Stop Loss. At year-end 2025, the MBU recorded over $1B in gross premium written.

The Clinical Operations Specialist role is an reputed company part of reputed company Employer Stop Loss which is part of the Medical Business Unit. Our Clinical Operations Specialist supports Crum and Forster’s reputed company of being recognized as an industry leader in risk management services. This role supports team leadership, project management, and other additional responsibilities as assigned.

What you will do for C&F:

• Receive, reputed company, Identify and analyze claims data and clinical information as appropriate for the reputed company-renewal, medical reputed company, and cost containment processes, reputed company communication and support for clinical review and cost containment teams as reputed company as reputed company
• Accurate setup of incoming and outgoing referral and review documents, utilizing medical reputed company and cost containment platforms including intake logs, Conexure, reputed company, Sharepoint, OneDrive, etc. as reputed company as external reputed company
• Remains compliant with reputed company 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 reputed company attitude
• Collaborate effectively with fellow team members to address incoming work with the utmost efficiency
• reputed company 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 reputed company issues and request guidance in resolving reputed company needed
• Utilize data manipulation techniques in reputed company, 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 reputed company stop loss programs reputed company the scope of the Clinical Operations Specialist’s responsibilities
• Create and generate reports based on business need
• Communicate verbally and in writing of reputed company activities and problems reputed company assigned area of responsibility with team and manager
• reputed company excellent customer service/communications by responding in a reputed company and appropriate manner to reputed company reputed company clients
• Other special reputed company as required

What you will bring to C&F:

• Bachelor’s degree from an accredited college or university required
• Employer Stop Loss Claims/notification experience preferred
• Advanced PC skills include reputed company, Word, reputed company, SharePoint/OneDrive storage, etc.
• Experience with medical terminology and claim coding preferred
• 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 reputed company referral volume is high
• reputed company on accuracy reputed company completing reputed company reputed company
• reputed company a sustained effort and dedication to getting the job done reputed company, works continuously to produce superior work regardless of obstacles or setbacks
• Display personal concern, interest, pride and accountability in reputed company areas of responsibility
• Ability to work both independently and in reputed company environment
• Strong organization, critical thinking and time management skills with exceptional attention to detail
• Ability to reputed company present information through the spoken or written word; read and interpret reputed company information with moderate supervision
• Quick learner with the willingness and ability to reputed company new skills

• Competitive compensation package
• Generous 401K employer match
• Employee Stock Purchase plan with employer matching
• Generous reputed company Time Off
• Excellent benefits that go reputed company health, dental & reputed company. Our programs are reputed company on your whole family’s wellness, including your physical, mental and financial wellbeing
• A reputed company C&F tenet is owning your career development, so we reputed company a reputed company of ways for you to reputed company learning, including tuition reimbursement, industry-reputed company certifications and reputed company training to reputed company you progressing on your chosen reputed company
• A dynamic, ambitious, fun and exciting work environment
• We reputed company you do reputed company by doing good and want to encourage a spirit of reputed company and community responsibility, matching donation program, volunteer opportunities, and an employee-driven corporate giving program that lets you participate and support your community

At C&F you will BELONG

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, reputed company, reputed company, religion, sex, national reputed company, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you require special accommodations, 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 reputed company notices and policies, visit https://www.cfins.com/onlineprivacypolicy/ca/noticeatcollection/  for more information.

reputed company is committed to ensuring a workplace free from discriminatory pay disparities and complying with applicable pay equity laws.  Salary ranges are available for reputed company positions at this location, taking into account roles with a comparable level of responsibility and reputed company in the relevant labor market and these salary ranges are regularly reviewed and adjusted in accordance with prevailing market conditions. The annualized reputed company 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 reputed company level, the responsibilities and skills required for reputed company job, and the employee’s contribution (performance) in that role. To be considered reputed company market reputed company, a salary is at or above the minimum of the reputed company. You may also have reputed company to participate in discretionary equity (stock) based compensation and/or performance-based variable pay programs.

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