Clinical Risk Manager, Cost Containment, C&F Stop Loss
Crum & Forster
full-time
Posted on:
Location Type: Remote
Location: New Jersey • United States
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Salary
💰 $64,700 - $147,100 per year
About the role
- 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.
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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical risk managementcost containment analysisclinical data evaluationevidence-based criteria applicationmedical underwritingdisease process knowledgetreatment plan knowledge
Soft Skills
relationship managementstrategic partnershipcommunicationclinical judgment
Certifications
Registered Nurse