Custom Clinical Specialist

Location Icon

Dallas, Texas, United States of America

Bag Icon

Client Services

Profile Icon

2500QW

Aplica ya

Custom Clinical Specialist

Location Icon

Dallas, Texas, United States of America

Bag Icon

Client Services

Profile Icon

2500QW

Apply now
Trabajar en Lockton

En Lockton estamos apasionados por ayudar a nuestra gente a alcanzar su máximo potencial. Somos colaboradores curiosos, orientados a dar respuestas y siempre nos esforzamos por mejorar nuestro desempeño y el de quienes nos rodean. Somos oyentes activos trabajando para garantizar la comprensión y solucionar problemas con alternativas innovadoras. Si te ves prestando un servicio de excelencia a los clientes, ayudando a la comunidad y formando parte de una cultura solidaria, eres uno los nuestros.

Ubicaciones secundarias

Kansas City, Plano

Business unit

Center Services

Schedule

Full-time

Lockton Benefits Offerings

Click Here

Workplace

Hybrid

Responsibility Icon

Tus responsabilidades

Lockton is currently seeking a Custom Clinical Specialist within its Advanced Medical Advisory Practice. The objective of this role is to provide complex claims management with the focus of identifying opportunities and working collaboratively with key stakeholders to reduce the severity of catastrophic claims while improving the quality of care for client health plan members. Clients include large commercial health plans and employers requiring a high touch approach with both reviews and client interaction and engagement.

• Review client’s medical and pharmacy claims data to identify opportunities to improve quality of care, enhance health outcomes, improve member experience and/or reduce cost of care.
• Review escalated and complex cases to identify and monitor opportunities.
• Actively participate in client strategy meetings to discuss high-cost member outlook and potential intervention opportunities.
• Interpret and articulate clinical findings to tell the story of the member’s health care journey and the impact of interventions recommended to the client.
• Explain disease states and associated costs to internal teams and external clients.
• Validate cost-of-care estimates used in the risk assessment of stop loss underwriting.
•  Consult and advise on medical/clinical care approaches.
• Serve as a subject matter expert regarding medical necessity issues, current standards of care and analysis for reimbursement of submitted stop loss claims.
• Serve in a leadership role for assigned clients.
• Lead client and stakeholder calls to review case level details.
• Ensure productivity meets practice needs.
• Execute opportunities agreed upon with clients and continue to follow up until completion.

Qualification Icon

Formación

• Licensure as a RN or Bachelor’s in Healthcare Management or related field.
• CCM, CPC or other certification or designation is a plus.
• 5+ years of clinical/risk management experience.
• 2+ years of claims and/or utilization review experience.
• Experience in health care costs and benchmarking.
• Working knowledge or experience in quality and care management.
• Knowledge of health insurance processes.
• Understanding of claim coding and processing, including CPT and ICD-10 coding.
• Ability to translate complex clinical topics and subjects to a non-clinical audience.
• Effective communication, presentation and negotiation skills.
• Demonstrated advanced analytical and problem-solving skills.
• Ability to work collaboratively with all levels of an organization in a dynamic and fast-paced environment.
• Proven record of accomplishment for managing multiple competing priorities.
• Strong organizational and time management skills with ability to handle multiple tasks simultaneously.
• Working knowledge of Microsoft products (Word, Outlook, PowerPoint, Excel).
• Ability to travel on an as needed basis.
• Legal right to work in the United States.

 

#LI-DG2

#LI-MM4

Declaración de igualdad de oportunidades

Lockton Companies se enorgullece de ofrecer a todos las mismas oportunidades para crecer y progresar. Estamos comprometidos con una cultura y un entorno inclusivos en los que tanto empleados, clientes y comunidades son tratados con respeto y dignidad.

En Lockton, apoyar a la diversidad, a la equidad y a la inclusión está arraigado en nuestros valores, y creemos con vehemencia que el mejor momento es cuando plenamente incluimos a todos. Nos esforzamos por propiciar una cultura solidaria que aprenda, celebre y prospere gracias a la amplitud de diferencias. Como tal, reconocemos que la contratación, el desarrollo y la retención de personas con diversos orígenes y experiencias es vital, además de que permite que nuestros colaboradores prosperen personal y profesionalmente, lo cual es fundamental para el éxito a largo plazo.

Acerca de Lockton

Lockton es la mayor correduría de seguros privada e independiente del mundo. Desde 1966, la independencia nos ha permitido servir a los clientes, cuidar de nuestra gente y retribuir a la comunidad. Como tal, los más de 10,000 Asociados que operan en más de 100 países están capacitados para hacer lo correcto cada día.

En Lockton, creemos en el poder de todas las personas. Tú perteneces a Lockton.

Cómo te apoyaremos

En Lockton te ayudamos a reafirmarte en todo lo que hagas. Tu éxito también es nuestro y te ofrecemos oportunidades para crecer y crear una trayectoria profesional gratificante, sea cual sea tu visión.

Estamos preparados para atenderte en donde estés y a medida que tus necesidades cambien con el tiempo. Además del seguro médico líder del sector, ofrecemos prestaciones adicionales para apoyar tu salud y bienestar general.

Más información sobre tu experiencia en Lockton

No se aceptan agencias

Cualquier agencia de empleo, persona o entidad que envíe un currículum no solicitado a este sitio lo hace entendiendo que el documento pasará a ser propiedad de Lockton Companies, Inc. Lockton Companies tendrá el derecho de contratar al solicitante a su discreción y sin ninguna tarifa debida a la agencia de empleo, persona o entidad que envíe el currículum. Las agencias de empleo que tienen acuerdos de tarifas con Lockton Companies deben enviar a los solicitantes con el Coordinador de Empleo designado por Lockton Companies para ser elegibles para las tarifas colocación.

Similar Vacancies

Ver todo

La vida en Lockton

Life at Lockton_Lockton Cares 3

February 3, 2026

Making an impact: An...
Fundación Cuenta Conmigo is a nonprofit foundation created to support low-income families with a family member suffering from cancer in the Chilean public health system. Specifically, the foundation assists families navigating the process of their child’s cancer treatment. This includes covering expenses and helping address needs that are not supported by the State or other non-governmental institutions. This organization is near and dear to Ana Wainer’s heart. Her son, Dante’s, close friend, Vicente, was diagnosed with pre-leukemia at age 9. After long and exhausting treatment, he underwent a bone marrow transplant. Unfortunately, it was not successful. Vicente later relapsed with Acute Myeloid Leukemia, "a diagnosis that profoundly changed the lives of his family and of all of us who knew him and accompanied them throughout the process,” Ana says. At age 11, after a long and courageous battle, Vincente passed away. “Despite the deep sorrow, Vicente left us invaluable life lessons and opened our eyes to a reality that often remains invisible to much of society,” Ana says. Shortly after his passing in March 2019, Vicente’s parents founded Fundación Cuenta Conmigo in 2020. Ana was a co-founder of the foundation and served as a volunteer member on the board of directors for three years. Through her role at Lockton, she coordinated activities between Lockton and the foundation as part of their Christmas initiatives since 2022. “From the moment I introduced the foundation at Lockton, the company was very open to collaborating and the response was overwhelmingly positive,” Ana says. “When I invited my colleagues to participate as volunteers, everyone showed a genuine interest in helping in any way needed.” Ana’s love and dedication towards this foundation have been recognized by Lockton, earning her the Lockton Cares Community Impact Award for the Latin America region. This award celebrates Lockton Associates across the globe who go above and beyond to improve their communities through volunteering and philanthropy. Each recipient can direct a $25,000 donation to a charity of their choice, funded directly by the Lockton family. “As first I was genuinely surprised to hear my name, followed by a deep sense of emotion, pride, and gratitude,” Ana explains. The award funds were used to purchase a brand-new utility vehicle, which is now used to distribute the various donations the foundation receives and delivers to families undergoing treatment in public hospitals. Donations include food, Christmas gifts, medical supplies, orthopedic equipment, and other essential items as needs arise. Ana had to step down from her role on the board of directors, but this award represents the support she wished she could have continued providing. “I feel like it is a kind of legacy that Lockton helped me leave for the foundation, for Vicente, and for his family,” she says. As she becomes more familiar with Lockton culture, Ana says it was a pleasant surprise to see that the importance of culture is not something just written on paper, but something truly reflected in the company’s commitment to charitable causes around the world. “Lockton genuinely cares,” Ana says. It’s no secret how much this foundation means to Ana, and she will continue contributing and encourage more people show support in any way they can. Fundación Cuenta Conmiga gave Ana an opportunity to discover an unfamiliar world—one that anyone could find themselves in one day. “It taught me to value what I have,” she says. “To be more empathetic toward those going through difficult times."
Article banner_1900x822_CaresReport.png

January 13, 2026

Lockton Releases Ann...
At Lockton, we believe business success and community impact go hand in hand. Our annual Lockton Cares Community Impact Report showcases how Lockton Associates around the world are creating meaningful change through volunteering, charitable giving, and sustainability initiatives that strengthen the communities where we live and work. This commitment to giving back isn’t just a program: it’s part of our culture. From thousands of volunteer hours to global giving campaigns, Lockton empowers its people to make a difference. That’s what sets us apart from our peers and makes Lockton a place where purpose and career growth thrive together. Why Lockton? Empowered people: We trust our Associates to lead, innovate, and give back. Global reach: Impact that spans continents and cultures. Caring culture: A privately held company focused on people, not shareholders. If you’re looking for a career where you can grow professionally while making a positive impact, Lockton is the place for you. Explore the full Lockton Cares Community Impact Report.
Life at Lockton_Lockton Cares 3

December 18, 2025

Making an impact: Ta...
Tabitha Leister has spent over a decade championing the most vulnerable members of her community: children who have experienced abuse and neglect. As a longtime board member of The Children’s Center, she’s helped drive critical support for more than 150 children each year, ensuring they receive therapy, medical care, and legal advocacy. Her passion and persistence have made her a powerful voice for those who often go unheard. From securing sponsorships for the annual Casino Night fundraiser to speaking at local events, Tabitha is a tireless advocate for children who have endured unimaginable hardship. “I want to continue to highlight the work of our child advocates and the comfort they provide to the most helpless victims. I want to highlight the hope they provide to children in seemingly hopeless situations,” she said. In recognition of her unwavering commitment to her community, Tabitha was named the 2025 Lockton Cares Global Community Impact Award recipient. The Community Impact Awards honor Lockton Associates across the globe who go above and beyond to improve their communities through volunteering and philanthropy. Each recipient can direct a $25,000 donation to a charity of their choice, funded directly by the Lockton family. However, the Global award is reserved for one Associate whose impact stands out among the rest, accompanied by a $100,000 donation funded by the Lockton family. “Being selected as the recipient of this award is both an honor and a deeply personal opportunity to make a meaningful impact on an organization I care about profoundly,” said Tabitha. “In my community, I regularly encounter children whose lives will be positively affected by the support this award enables. While I may never know exactly who benefits, I am confident that the impact is real and close to home. Living in a small community means that every time I step outside my front door, I am among those whose lives are being touched.” Tabitha hopes a portion of the donation will be allocated to support the addition of a child therapist who can provide ongoing care to children served by the center – an investment that would significantly enhance the long-term impact the organization is able to make in the lives of children. “Tab is a tireless advocate for children who have experienced abuse and/or neglect in their homes,” said her nominator. “She works to support the Children's Center by serving on the board, volunteering her time, and dedicating tons of time and energy to their annual fundraiser each spring. For as long as I've known Tab, she has been raising awareness of child abuse and neglect by promoting the positive impact the Children's Center has for victims.” Tabitha credits Lockton’s culture for empowering her to make a difference. “One of my favorite aspects of working at Lockton is the company’s genuine commitment to giving back,” she said. “Lockton empowers employees to make a difference in their own communities by providing the flexibility to engage in causes that matter personally. But what stands out most is that Lockton’s focus has never been on gaining recognition, but rather on encouraging each of us to support the organizations and initiatives that speak to our hearts. The fact that a community as small as mine can be recognized and supported by an organization as large as Lockton is something I will carry with me moving forward. It’s a powerful reminder that meaningful impact doesn’t depend on size, but on intention—and Lockton continues to lead with both.”
Life at Lockton_Lockton Cares 3

October 27, 2025

Making an impact: Si...
At a pivotal moment in her career, Simone Ramos woman found herself searching not just for growth, but for meaning. That search led her to Sou Segura, a nonprofit association that would become more than just a professional network: it became a sanctuary of support, learning, and inspiration. Since its founding, Simone was there, driven by a belief in the transformative power of education and female leadership. “Throughout my career, I knocked on many doors and heard many ‘no’s,” said Simone. “Sou Segura, through its lectures and culture of encouragement, helped me change my perspective and turn each obstacle into learning." Today, Simone serves as the volunteer director for institutional programs for Sou Segura. Her initiatives are focused on mentorship, which has already helped over 240 women, the Sou Segura Column, which amplifies the voices of women in the industry, and the “Juntos por Elas” (Together for Them) program, which brings together CEOs and industry leaders for monthly meetings to promote reflections on equity, inclusion, and empathy. Additionally, she helped conceptualize the organization’s book, Fala Mulher, a collection of the most read and inspiring articles from the Sou Segura Column. The book became a hit in the Brazilian insurance industry. In recognition of her unwavering commitment to empowering women in the insurance market, Simone was named a 2025 Lockton Cares Global Community Impact Award recipient. The Community Impact Awards honor Lockton Associates across the globe who go above and beyond to improve their communities through volunteering and philanthropy. Simone received a USD $50,000 donation to a charity of her choice, funded directly by the Lockton family. Naturally, she chose Sou Segura. “I was completely surprised during our annual Lockton Brazil Leaders’ Meeting in September. I was deeply moved and speechless — it was a moment when a real film played in my mind: my journey, the challenges, and the joy of being able to support other women. Knowing that a social project led by Brazilian women was recognized globally by the Lockton family touched me in a very special way,” she said. The donation, which is the largest in Sou Segura history, will be used to fund over 30 MBA scholarships for women in the insurance sector. Her own academic journey, which began after the age of 40 and led to a Master’s degree, international certifications, and now a PhD in Naval Engineering, is a testament to what’s possible when determination meets opportunity. “I know there are many women with great potential who face financial and family barriers, often balancing multiple roles. Education transformed my life and career, and that is why this award holds such deep emotional value,” she said. Looking ahead, she envisions a permanent scholarship fund and a network of Latin American women executives where each woman becomes an agent of transformation in her own community. With Lockton’s caring culture, she feels empowered to align her passions with her profession. “I would like to dedicate this recognition to the women who paved the way before us — and to those who will come after. This award is not just a personal achievement but a celebration of what is possible when purpose, courage, and care walk together. May it inspire other women to believe that it is possible to grow, care, and transform — all at the same time.”