Senior Claims Specialist, Stop Loss
Plano, United States of America
Claims
2400GX
Working at Lockton
At Lockton, we’re passionate about helping our people achieve their ultimate potential. Our people are curious, action-oriented and always striving to make ourselves and those around us better. We’re active listeners working to ensure understanding and problem solvers developing innovative solutions. If you can see yourself delivering excellent service to clients, giving back to our communities and being a part of our caring culture, you belong here.
Minneapolis
Business unit
Lockton-Dunning Series
Schedule
Full-time
Job type
Standard
Workplace
Hybrid
Your Responsibilities
Lockton Dunning Benefits is currently seeking a Senior Claims Analyst responsible claims resolution by partnering with internal clinical staff, vendors and insured clients. The ideal candidate will demonstrate a high level of professionalism; possess the ability to work well in a fast-paced environment and the flexibility to easily adapt to changing priorities.
- Participate in discussions on strategic planning for specialized claims resolution that helps to drive better insured care and cost savings
- Collaborate with internal Clinical Team to review high claim projections and identify overall risk tolerance
- Develop financial models and reports for client service team, provides interpretation and implication of recommended alternatives
- Serve as subject matter expert to Claims Analysts, managing escalations and providing training and support
- Establish timelines for client deliverables and oversee process to ensure deadlines are met
- Collaborate with team to ensure proper review of all agreements and/or documents
- Works with Service Team and Internal Legal Counsel on compliance issues
- Create and manage reporting tools to identify variances and potential high risk claims to proactively address opportunities to reduce medical costs
- Work directly with Service Delivery Team to recommend specific client solutions/options on high claims
- Assist in developing an implementation plan and managing deliverable timelines to ensure they are met
- Interpret clients’ current coverages and identifies/recommends gaps, alternatives, additional plan design changes, etc.
- Present Service Teams and Clinical Team with findings on a) large claims b) abnormal utilization results c) monthly claims experience d) set strategies and goals and e) if needed conduct on-site claims visits
- Address outstanding issues and claims matters with clients, carriers and administrators
- Research and understand industry trends and carrier product offerings
- Maintain knowledge of governmental compliance and regulations to educate and consult client(s)
- Other responsibilities as assigned and/or needed
Qualifications
- Bachelor’s degree in Business related field and/or equivalent years of experience
- A minimum of 3 years’ experience in the insurance industry, specifically in medical, high cost claims
- Strong knowledge of differing financial arrangements and products available to clients (i.e. fully insured, self-insured, minimum premium, ASO)
- Strong analytical skills and experience with creating actionable solutions
- Strong working knowledge and understanding of medical billing, claims processing and collections rules and regulations
- Strong knowledge of Microsoft Office Suite (Word, Outlook, Excel, and PowerPoint)
- Excellent organizational, communication and time management skills
- Legal right to work in the United States
#LI-KB1
Equal Opportunity Statement
Lockton Companies is proud to provide everyone an equal opportunity to grow and advance. We are committed to an inclusive culture and environment where our people, clients and communities are treated with respect and dignity.
At Lockton, supporting diversity, equity and inclusion is ingrained in our values, and we believe that we are at our best when we fully embrace everyone. We strive to cultivate a caring culture that learns from, celebrates and thrives because of our breadth of differences. As such, we recognize that recruiting, developing and retaining people with diverse backgrounds and experiences is vital and enabling our people to thrive personally and professionally is critical to our long-term success.
About Lockton
Lockton is the largest privately held independent insurance brokerage in the world. Since 1966, our independence has allowed us to serve our clients, take care of our people and give back to our communities. As such, our 10,000+ Associates doing business in over 100 countries are empowered to do what’s right every day.
At Lockton, we believe in the power of all people. You belong at Lockton.
How We Will Support You
At Lockton, we empower you to be true to yourself in all that you do. Your success is our success, and we provide opportunities to help you grow and create a rewarding career path, however you envision it.
We are ready to meet you where you are today, and as your needs change over time. In addition to industry-leading health insurance, we offer additional options to support your overall health and wellbeing.
No Agencies Please
Any Employment Agency, person or entity that submits an unsolicited resume to this site does so with the understanding that the applicant's resume will become the property of Lockton Companies, Inc. Lockton Companies will have the right to hire that applicant at its discretion and without any fee owed to the submitting Employment Agency, person or entity. Employment Agencies, who have fee Agreements with Lockton Companies must submit applicants to the designated Lockton Companies Employment Coordinator to be eligible for placement fees.
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