The Sr. Claims Specialist is responsible for managing the full lifecycle of stop loss claim submissions with minimal oversight. This role ensures accuracy, timeliness, and quality in the claims process while serving as a trusted partner to clients, carriers, and internal stakeholders.
Responsibilities
- Responsible for managing the full lifecycle of stop loss claim submissions with minimal oversight.
- Ensures accuracy, timeliness, and quality in the claims process, serving as a trusted partner to clients, carriers, and internal stakeholders.
- Acts as a subject matter resource within the team and can operate independently to resolve routine issues and ensure seamless execution.
- Manages end-to-end submission and tracking of stop loss claims with a focus on accuracy, speed, and completeness.
- Interprets and analyzes claim data, eligibility documents, EOBs, and carrier-specific requirements.
- Submits claims (specific and aggregate) to carriers and ensure proper follow-through until reimbursement is received.
- Identify and resolve discrepancies or delays directly with carrier contacts, requiring little to no escalation.
- Serve as a consistent point of contact for claims-related questions from internal account teams, Lockton Stop Loss associates, carrier and/or clients.
- Proactively communicates with carriers to troubleshoot processing issues and clarify submission requirements.
- Keeps stakeholders informed of claim statuses, outstanding documentation, and anticipated turnaround times.
- Maintains detailed and organized claim records, logs, and audit trails in accordance with Lockton standards.
- Supports reporting efforts related to claim volumes, reimbursement trends, and turnaround times.
Preferred Qualifications
- Preferred location: Plano but open to remote
Compensation
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Work Arrangement
Hybrid — Plano — Remote work is an option, though Plano is the preferred location.
