Custom Clinical Specialist

Location Icon

Dallas, Texas, United States of America

Bag Icon

Client Services

Profile Icon

2500QW

Apply now

Custom Clinical Specialist

Location Icon

Dallas, Texas, United States of America

Bag Icon

Client Services

Profile Icon

2500QW

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

Plano, Kansas City

Business unit

Lockton-Dunning Series

Schedule

Full-time

Lockton Benefits Offerings

Click Here

Workplace

Hybrid

Responsibility Icon

Your Responsibilities

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

Qualifications

• 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.

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 12,500+ Associates doing business in over 140 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.

Similar Vacancies

View all

Life at Lockton

Life at Lockton Article Header - Add Victor

February 24, 2025

Lockton announces pa...
We are proud to launch our new partnership with add-victor, an organisation who helps place elite athletes and exceptional individuals into corporate roles. Add-Victor leverages their unique skills and experiences for career success beyond their original fields. Martyn Worsley, Lockton Chief People Officer, said: “This collaboration is about championing future talent by tapping into their diverse experiences and skill sets, such as resilience, accountability and innovative thinking, which are essential to thrive in today’s business environment. Lockton has a unique culture that aligns strongly with these individuals and allows us to continue to expand our future talent pool whilst investing in our ongoing success.” To kick off the partnership, we hosted an exclusive event with 40+ professional athletes, including 10 Paris Olympians. Attendees heard inspiring insights from Tim Prendergast (New Zealand Paralympian), who shared his transformative Paralympic journey, revealing how the challenges of sport forge the resilience needed to overcome life's toughest obstacles. Our own Gordon D’Arcy (former Leinster, Ireland and British and Irish Lions rugby player), who successfully transitioned from elite sports to the corporate world, talked about his journey and how he mastered the art of collaboration and teamwork. We’re excited about the opportunities ahead and look forward to welcoming more exceptional talent to Lockton and Lockton Re.
Life at Lockton Article Header Carlo Ramadoro

February 4, 2025

My career, my story:...
I've been at Lockton for 12 years, and I still love going to work every day. Not everyone can say that. I joined Lockton in 2012 as a broker in Professional Indemnity. Fresh out of university, I was searching for a job in insurance, which led me to Lockton. I started in the Global Professions unit, focusing on mitigating risk for companies in law, accounting, engineering, and more. I learned key business and interpersonal skills in this role, but after four years, I was ready for a new challenge. I spoke with my manager, who supported my transition to a new team – the Cyber & Technology team in the Global Professional & Financial Risks division. In that role, I focused on U.S. and international cyber and professional indemnity policies. Through this experience, I learned first-hand that Lockton is dedicated to retaining good talent and finding the right position for everyone. I didn't just join a new team; I found a new challenge – a new passion. I loved the challenge of cyber. It's a dynamic, young market that constantly changes. It's the risk of the future and challenges my knowledge daily. In some areas of insurance, we must get very technical and have a deep understanding of a specific industry. However, we must learn about every industry in Cyber, which drives me. I genuinely care about our clients and how they run successful businesses – I can do that in this role. In addition to caring for my clients, I can care for my teammates. I enjoy helping my team members succeed—with clients, new business, whatever it may be. Since I can remember, I have been competitive, and I love winning. However, a few years back, I learned that helping a teammate win is even more rewarding. When I became a manager, Lockton was there to help me. Managing people comes with challenges, and I had to learn quite a bit. However, my managers coached me on how to have hard conversations and trained me to lead with empathy. We all have different backgrounds and challenges in our personal lives, and perspective is so important. These backgrounds and perspectives are celebrated at Lockton. Everyone I work with is understanding of personal life and pressures. Everyone is willing to listen to you, learn about your background, and understand your perspectives. We have this incredibly flexible environment where we can do everything we want – well, within some parameters! Our culture of support, empowerment, and care has helped me excel throughout my time here. It's important to have a culture where we work hard but also have laughter and joyfulness, and we have that here. Lockton has supported me by creating a great working environment. We're serious and work hard, but being in a caring environment is nice. There's a spirit here, and that's not a lie or a marketing thing – our culture really does set us apart from the rest. For those considering Lockton, I have some advice: Throw yourself in! Try to embrace our culture and be curious—don't just be a passenger. The people who are successful here are the ones who stay curious, aren't afraid of getting their hands dirty, and are willing to help for the greater good. It takes some patience, too—business won't just fall into your lap, but if you are proactive and show people you are interested, you can be successful here.
Life at Lockton Article Header_Graham Turville-Ince

December 17, 2024

Making a difference:...
Graham Turville-Ince's commitment to the Cerebral Palsy Alliance (CPA) is more than a passion - it's a mission to create meaningful change. His dedication began at CPA's Randwick Race Day, where he met a 6-year-old girl whose life was transformed by early intervention programs. "Her progress was remarkable, and seeing her parents' strength, especially with a second child also affected by cerebral palsy, left a lasting impression," Graham shared.  This experience fueled his ongoing involvement. From volunteering at CPA's headquarters in Sydney to raising over $6,000 through the STEPtember challenge, where he took over one million steps to support the cause, Graham continues to raise funds and awareness for CPA. He also works to inspire others, whether colleagues or clients, to join in advocating for CPA's mission.  Graham's efforts were recently recognised with Lockton's prestigious Community Impact Award. Funded by the Lockton family, this honour celebrates Associates making a difference in their communities through volunteering and philanthropy. The award includes a USD 25,000 donation for the recipient's charity of choice, which Graham directed to CPA. "Presenting that cheque, knowing the impact it will make, was an unforgettable moment," he said. "I felt genuinely humbled. It's incredible to be recognised alongside many passionate and impactful colleagues."  The donation will go to providing vital therapy, respite services and a number of other programs for people living with cerebral palsy and their families. Lockton's caring culture played a critical role in Graham's ability to support CPA, allowing him to lead by example at work and in the community. "Lockton doesn't just support my passion- it enables it," he reflected. "From hands-on charity days to backing vetted causes, the encouragement from my team is invaluable."  Looking ahead, Graham is determined to expand his advocacy efforts for CPA. He's working on transitioning fundraising events from his previous involvement with Oxfam to CPA and aims to inspire his professional network to support this vital cause. "Collaboration is key, whether it's colleagues, clients, or other organisations," he said.  Graham remains focused on expanding CPA's impact, inspiring action within his networks, and driving lasting change. "When we work together, the possibilities for transformation are endless," he shared. 
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.