Complex Claims Specialist

Dallas, Texas, United States of America

Claims

2402BX

Apply now

Dallas, Texas, United States of America

Claims

2402BX

Apply now

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.

Secondary locations

Houston, Plano, St. Louis

Business unit

Lockton-Dunning Series

Salary

$65,600-$82,100

Schedule

Full-time

Job type

Standard

Workplace

Remote

Your Responsibilities

Lockton is currently seeking a Clinical Claims Specialist within our Specialty Practice unit. The objective of this role is to improve and reduce the severity of complex and catastrophic claims, reduce the cost of risk while improving the health of our employer client’s employee health plan.

• Provide explanation of disease states and associated costs to internal and external stakeholders.
• Provide cost-of-care estimates used in the risk assessment of stop loss underwriting.
• Consult with and advise underwriting on medical/clinical care approaches, standards of care and research of data for new business and renewals.
• Serve as a resource regarding medical necessity issues, standards of care and analysis for the reimbursement of submitted stop loss claims.
• Review claims and clinical documents to identify and monitor opportunities to increase member quality of care and overall cost reduction.
• Collaborate with various key stake holders to strategize clinical and cost savings strategies and assist on execution of plan.
• Coordinate implementation of claims savings solutions with Lockton Client Service Teams, TPAs, and stop loss carriers including regular tracking to measure savings and plan performance.
• Manage and organize task lists and open items and cases.
• Attend team clinical rounds to discuss cases and strategy solutions.

Qualifications

• Licensure as a RN or Bachelor’s in Healthcare Management or related field.
• A minimum of 5 years of clinical/risk management experience.
• Experience and/or knowledge of health insurance processes.
• CCM, NANCM, or other certification or designation is a plus.
• Working knowledge or experience in quality and care management.
• Proven time management experience.
• Strong organizational skills with ability to handle multiple tasks, in a fast-paced environment.
• Excellent oral and written communication skills.
• Ability to translate complex clinical topics and subjects to a non-clinical audience.
• Demonstrated advanced analytical and problem-solving skills.
• Working knowledge of Microsoft products (Word, Outlook, PowerPoint)

#LI-JM1

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.

Learn more about your Lockton experience

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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January 22, 2025

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December 17, 2024

Making a difference:...

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Life at Lockton Article Header_Kate Coppinger

December 16, 2024

My career, my story:...

From intern to consultant, Kate Coppinger's career at Lockton reflects the power of curiosity, hard work, and mentorship. She began her journey as a Marketing and Operations Intern with the Producer Lifecycle team in Kansas City during the summer of 2022. She found a pivotal mentor in Julie Gibson, now Lockton's Chief Marketing Officer, who guided her through her early career decisions. Her journey led her to Chicago, where she explored client-facing roles and now thrives as an Operations Consultant with the Midwest Growth and Operations team. "Lockton's commitment to developing Associates and empowering their success is unmatched," Kate shared. "At Lockton, you can truly carve out your career path." Learn more about her journey and the lessons she's learned along the way in her own words. --- Can you share your journey from a Marketing Intern to a full-time Associate at Lockton? Once I realized that I wanted to continue my career full-time at Lockton, I began having conversations with various Associates and leaders in the Kansas City and Chicago offices. I wanted to learn more about each of the different early career opportunities in People Solutions and Risk Solutions and evaluate what would best fit me. I also wanted to investigate if the same Lockton culture in Kansas City was present in Chicago. I decided to travel to the Chicago office to see if it was the right fit for me and meet with a few Associates. There, I met the president of the office and a former People Solutions intern turned Account Executive. By the end of the day, I could see myself thriving in Chicago with Lockton. All my conversations with Lockton Associates were paramount to my decision to continue at Lockton. They were a testament to Lockton's commitment to the development of Associates and the opportunity for personal and professional growth. What lessons have you learned as you've transitioned through different roles at Lockton? Lockton is a dynamic organization open to cross-functional promotions and transitions. I am a direct example of this, and I have seen many others go on their own journey here. I have learned the importance of openly sharing my interests and passions with my managers. I would not be in my role now if I didn't speak up. At Lockton, you can create your own career path that supports your passions – you are not stuck in one specialty or department forever.” Hard work pays off. Lockton appreciates drive and work ethic. Associates are recognized and rewarded accordingly. Lockton values those who are involved not only in the market and within our organization but also in our communities. Lastly, and arguably most importantly, I have learned to be a student of business. Staying curious, asking questions, and understanding the 'why?' have all helped me progress in my career. Being a student of business is to be a lifelong learner. What sets Lockton apart from other organizations? Lockton is a flat organization. There are no barriers to accessing leadership or managers. In fact, leadership is more than willing to connect individually with Associates to understand how they can improve their lives and responsibilities. At Lockton, Associates truly are our most valuable asset. What has been your "Lockton Moment" — a time when you knew Lockton was the right place for you? I knew Lockton was right for me during my time as an intern. I felt welcomed by Associates and even global leaders who were invested in my success. Every person I met cheered me on and dedicated themselves to helping me learn. I felt energized to make an impact, lead my peers, and grow professionally and technically as much as possible. My "Lockton Moment" came over time as I experienced firsthand the caring culture and genuine investment in my success. An example of this is when the global leadership team made time to attend our intern presentation in person. I was provided impactful feedback, along with encouragement and advice for my future career. This made a lasting impact on me because I felt appreciated and that my contributions mattered. I left my summer internship knowing if I pursued a full-time career with Lockton, I would be valued, supported, and empowered. How would you describe Lockton's culture to someone unfamiliar with it? Lockton's caring culture makes showing up to work every day so easy. On day one, I met and fostered lifelong friendships, not just coworkers. Our leaders genuinely care about the well-being and advancement of Associates. By being a privately held organization, our leaders have the flexibility and control to make business decisions that best support our three stakeholders: our Clients, our Associates, and our Communities. Lockton is an organization that rewards high-quality performance and supports Associates with proper learning and development to be successful.

November 1, 2024

Making an impact: Ra...

The Community Impact Award, funded by the Lockton family, honors Associates who go above and beyond to improve their communities through volunteering and philanthropy. This recognition enables each award recipient to direct a $25,000 donation to a charity of their choice, provided by the Lockton family. This year, both Rae Lynn Zachary and Shannan Smith were celebrated for their work with the Leukemia & Lymphoma Society (LLS), an organization dedicated to fighting blood cancers and improving the lives of patients and their families. Since 2011, Rae Lynn has been a dedicated participant in LLS’s fundraising walks, organizing teams in Lockton’s San Francisco office before transitioning to individual efforts. To date, she’s raised more than $37,000 personally, with an additional $33,000 from team contributions. Her involvement stems from personal loss: “I first became involved after my uncle passed away from leukemia in 2009,” she shares. “But it really became personal when a colleague’s infant son was diagnosed with the disease. Seeing him survive after months of treatment gave me a reason to keep going. Since then, I’ve lost two more family members and a friend to leukemia. That’s what drives me to keep walking and fundraising year after year.” For Shannan, supporting LLS began as a way to rally around a family friend diagnosed with acute lymphocytic leukemia (ALL) in 2014. To raise awareness, she organized the first "Lemonade for Leukemia" stand within her neighborhood, raising $415 in one weekend and turning the event into an annual summer tradition. “We then walk in the Light the Night event each September,” Shannan adds. “This cause became even more personal this year when a cousin was diagnosed and recently underwent a transplant. I’m hopeful that she, too, will be able to look back one day and see all the progress the LLS has made.” Both Rae Lynn and Shannan share a commitment to instilling the value of community service in their families, hoping to inspire the next generation to carry on their legacy. For Rae Lynn, involvement in LLS is a lasting commitment she hopes to carry into retirement. Shannan, inspired by her role as a mother and leader, aims to pass down her passion for service to her three daughters, saying, “I want them to understand the importance of giving back to those in need when you have the means to do so.” By demonstrating compassion and resilience through their work, both women have become role models within Lockton, their families and communities. The Community Impact Award holds deep significance for both women. “This award isn’t just about the donation—it’s a reflection of Lockton’s commitment to giving back,” Rae Lynn says. “Lockton encourages us to get involved in the causes we care about and provides the support to make that happen.” Shannan echoed this sentiment, describing how Lockton’s C.A.R.E. Committee and volunteer days foster a culture of compassion: “Lockton truly cares about what drives its Associates, giving us the flexibility to serve our clients while also supporting our community work.” Through their dedication and Lockton’s support, Rae Lynn Zachary and Shannan Smith are making a lasting impact, offering hope to those affected by blood cancer.