[Hiring] VP, Managed Care @Crum & Forster

Role Description

This individual will have primary responsibility for Workers’ Compensation vendor management with an emphasis on medical cost containment. In order to improve healthcare quality and outcomes, and promote loss cost containment, leads the development and continued implementation of the Managed Care Claim department as part of Workers’ Compensation Claims. This position works with the leader of the Workers’ Compensation line of business to set strategy for medical management, then executes improvement initiatives, leverages technology and AI solutions, as well as have responsibility for ongoing refinements to the business model inclusive of workflows, process and key performance indicators. Monitors compliance with changing regulatory requirements at Federal and State level ensure indicators meet or exceed requirements. Strong analytical skills, use of data, modeling tools and in-depth knowledge of trends impacting the Workers’ Compensation industry are required.

What you will do for C&F:

• Responsible for establishing an infrastructure to support the negotiations, implementation and oversight with all contracted vendors.
• Vendor selection through Request for Proposal process, due diligence and contracting.
• Manage and audit vendors and develop strategies for improved processes and cost savings solutions with an emphasis on Workers’ Compensation medical management products and services.
• Oversee and maintain day-to-day operations of all managed care vendor programs, effectiveness and results.
• Develop metrics reporting from all vendors.
• Strong analytical skills to evaluate effectiveness of programs.
• Establish and maintain internal and external relationships and lead a high performing and goal-oriented team.

Product and Business Development

• Continuous development of product solutions to improve cost containment savings.
• Responsible for setting the vision and implementing strategies for creative cost containment initiatives.
• Business case development and full vetting of new products.
• Present business solution to Claims Executive staff and other key stakeholders.

Management and Communication

• Regular communication to Claims Leadership and other stakeholders on results and areas of focus and improvement.
• Serve as liaison between vendors and claims staff.
• Develop, maintain, and manage a Managed Care Scorecard that encompasses all cost containment services.
• Audit, measure, report and evaluate all vendor’s performance.

Qualifications

• Bachelor’s degree or equivalent.
• 15+ years of experience.
• Minimum of 5 years’ experience in leading a Workers’ Compensation Managed Care operation.
• 5 plus years clinical experience preferred.
• Extensive background in Workers’ Compensation and Managed Care within an insurance operation is required.
• In-depth knowledge of medical bill review processes and procedures in a full service environment.
• Strong knowledge of medical terminology and managed care operations, across multiple jurisdiction states.
• Ability to travel to other locations across the country as well as to our vendors is required.

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, focused on your whole family’s wellness.
• Opportunities for career development including tuition reimbursement, industry-related certifications and professional training.
• A dynamic, ambitious, fun and exciting work environment.
• Encouragement of social and community responsibility through matching donation program, volunteer opportunities, and an employee-driven corporate giving program.

Company Description

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.