Clinical Risk Manager, C&F Stop Loss
Company: Crum & Forster
Role summary
Clinical Risk Manager, C&F Stop Loss is a full-time role at Crum & Forster in Morristown, New Jersey, United States (remote). Posted 2026-10-22. Salary: USD 71,300–134,000 per year. Experience level: 5-10. No degree required.
- Job title
- Clinical Risk Manager, C&F Stop Loss
- Company
- Crum & Forster
- Location
- Morristown, New Jersey, United States
- Work arrangement
- remote
- Employment type
- full-time
- Category
- Healthcare Support
- Salary
- USD 71,300–134,000 per year
- Experience level
- 5-10
- Degree required
- No
- Date posted
- 2026-10-22
You’ll love this remote opportunity to manage clinical risk for a well-established company that genuinely values empowered decision-making. With a competitive salary range and no degree requirement, this is a fantastic chance to grow your career in the insurance sector while working with a team that prides itself on stability and expertise.
Job description
Crum & Forster Company Overview
Crum & Forster (C&F) provides market leading property & casualty, accident & health, specialty and standard commercial lines insurance solutions. A true underwriting company, we have a 200-year history of helping our customers manage risk with laser-focused expertise, integrity and discipline. Our people are empowered to make decisions and problem-solve with you smartly and swiftly. Our annual gross written premium is 6.2 billion. C&F enjoys a financial strength rating of "A+" (Superior) by AM Best.
Our most valuable asset is our people. We have 3000 employees, and locations throughout the United States and India. With our employee-first focus, the Company is consistently recognized as a great place to work, earning multiple workplace and wellness awards, including the Great Place to Work® Award, Fortune 100 Best Companies to Work For, Fortune Best Workplaces for Parents, Fortune Best Workplaces for Millennials, and many others.
C&F is part of Fairfax Financial Holdings. For more information about C&F, please visit our website: www.cfins.com
Job Description
This is a remote role.
The Accident & Health Division (A&H), established in 2000, 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. Gross premium written in 2025 surpassed $2.4B.
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; 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.
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Information about the Role, Line of Business and Team:
The Senior Clinical Risk Manager role utilizes a high level of experience and advanced knowledge regarding nursing, complex medical conditions, risk, prognoses, treatment plans, and utilization of care. This senior-level position provides accurate current and next year cost projections and savings opportunities to C&F while independently troubleshooting complex clinical, claims, and data issues. The Senior Clinical Risk Manager also serves as a resource to the Clinical Risk Management team by leading work efforts, mentoring team members, and supporting the onboarding and training of new employees.
What you will do:
. Medical Risk Assessment & Clinical Evaluation
Review and analyze all data and documentation within existing systems and that provided by Underwriting including but not limited to diagnoses, procedures, case management notes, treatment plans, and comorbid conditions to assess validity of data and clinical risk.
Identify clinical factors that may impact underwriting outcomes or financial exposure at a claimant and population health level for Underwriters to leverage in their rating of the group.
Exercise independent clinical judgment to synthesize complex medical information into clear risk conclusions that support sound underwriting decisions.
Support the development and implementation of clinical risk management strategies for high-cost, complex claims through strategic identification of cost-containment opportunities while reviewing all available data for MUW review.
Cross-refer to cost containment when appropriate and participate in cost containment work as requested.
Strategic Underwriting Partnership
Triage and prioritize requests for medical underwriting review based on business urgency, workload capacity, and alignment with underwriting and leadership priorities
Act as a strategic partner to underwriting by applying evidence-based criteria and sound clinical judgment to evaluate complex clinical and claims data to identify, quantify, and advise on significant risks, directly influencing underwriting strategy and decisions.
Client & Stakeholder Management
Develop, maintain, and manage strong relationships with internal and external clients, Third-Party Administrators (TPAs), and vendors, championing exemplary customer service standards.
Consult with clients and teams on submitted data for MUW, program development, quality improvement, and claim issues.
Act as a point of contact for escalations and participate in calls with internal and external clients as needed.
Data Management, Reporting, & Quality Assurance
Ensure accurate entry, validation, and analysis of medical underwriting data within the claims system, maintaining high standards of data integrity.
Perform accurate and thorough data scrubbing of reports for medical underwriting reviews, leveraging advanced skills in Excel and using AI tools and other available tools and resources.
Request needed medical and claim data, collect said data and create reports in collaboration with Digital Transformation and/or IT teams to streamline departmental processes.
Identify and resolve data gaps and discrepancies to ensure comprehensive data for cost containment interventions.
Maintain clear records to support transparency and defensibility of underwriting decisions as it relates to clinical evaluation.
Participate in quality assurance activities related to medical underwriting evaluations and engage in peer review and audit processes as requested.
Subject Matt
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