Clinical Operations Manager - Eatontown, United States - Crum and Forster

Description

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 MBU takes a full-spectrum approach to designing and servicing a robust slate of products tailored to needs in Employer Stop Loss, Excess Medical, Life, and Ancillary and Supplemental benefits. Our diversified business model includes program partnerships as well as direct sales in Employer Stop Loss. At year-end 2023, the MBU recorded $741M in gross premium written.

Information about the Role, Line of Business and Team:

The Clinical Operations Manager uses a high level of experience and knowledge of insurance, stop loss insurance, reinsurance, claims, medical underwriting, and underwriting to support the daily functions of the Clinical Risk Management Department to ensure productivity and quality.

What you will do:

Facilitate maintaining accurate system tracking of cost containment and medical underwriting
• Identify and analyze gaps between stop loss RFP data and notification/claims data, and create processes to ensure accurate projections are made
• Develop, streamline, and oversee the effective utilization of software used to support medical underwriting (currently AMS Profiler)
• Educate junior staff on stop loss cost drivers, claims, cost containment, and proper interactions with internal & external stakeholders
• Standardize and maintain policy and procedures for the Clinical Risk Management team
• Develop and maintain strong client, TPA and vendor relationships
• Oversee and support internal and external communications (newsletters, webinars) and interactions with marketing and sales
• Create and maintain accurate cost containment savings reporting for use by internal and external stakeholders
• Assist with system-based and manual reports for use by management to monitor department-wide activity and performance
• Collaborates with other team members to coordinate the management of shared mailboxes
• Provide support with developing and working closely with Robotics and other C&F teams to streamline processes within the clinical risk management program, where applicable
• Keeps manager informed verbally and in writing of all activities and problems within assigned area of responsibility
• Provides excellent customer service/communications by responding in a timely and appropriate manner to all internal and external clients
• Support referrals of claimants for reserves and cost containment according to notice guidelines
• Support cost containment services and vendor interactions with internal and external customers
• Supports timely and accurate intake, screening, triaging, tracking, and maintenance of potential claim notifications and associated reports/documentation
• Remains compliant with all company and department policies and procedures and service level agreement standards
• Explores, develops and implements new methods and processes which increases efficiency and effectiveness to attain achievement of both individual and organizational goals
• Other special projects and duties as required

What YOU will bring to C&F:

• 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 to take action when required
• Accuracy when completing all projects
• A sustained effort and dedication to getting the job done well, while working continuously to produce superior work regardless of obstacles or setbacks
• Demonstrate a solid work ethic and maintain a positive attitude
• Displays personal concern, interest, pride and accountability in all areas of responsibility
• Ability to work both independently and in a team environment
• Strong organization and time management skills with exceptional attention to detail
• Ability to clearly present information through the spoken or written word, as well as read and interpret complex information with moderate supervision
• Ability to effectively handle multiple tasks in a fast-paced environment
• A quick learner with the willingness and ability to acquire new skills

Requirements:

• Bachelor's degree from an accredited university or equivalent experience required
• 8 years of experience and 5+ years of Employer Stop Loss experience required
• Strong PC skills including Excel, Word, Outlook
• Versed in medical terminology and medical claim coding preferred

• 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
  

At C&F you will BELONG

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 accommodation, 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 privacy notices and policies, visit for more information.

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 $74,900.00 to a maximum of $170, 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.

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