Lockton Northeast is hiring a Sr. Claims Specialist into a senior role responsible for managing the full lifecycle of stop loss claim submissions with minimal oversight. You will act as a subject matter resource and trusted partner to clients, carriers, and internal stakeholders.
What You'll Do
- Manage the full lifecycle of stop loss claim submissions with minimal oversight.
- Ensure accuracy, timeliness, and quality in the claims process.
- Act as a subject matter resource within the team and operate independently to resolve routine issues.
- Manage end-to-end submission and tracking of stop loss claims with a focus on accuracy, speed, and completeness.
- Interpret and analyze claim data, eligibility documents, EOBs, and carrier-specific requirements.
- Submit 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 communicate with carriers to troubleshoot processing issues and clarify submission requirements.
- Keep stakeholders informed of claim statuses, outstanding documentation, and anticipated turnaround times.
- Maintain detailed and organized claim records, logs, and audit trails in accordance with Lockton standards.
- Support reporting efforts related to claim volumes, reimbursement trends, and turnaround times.
- Ensure that all claim submissions meet quality control standards and internal documentation policies.
- Meet monthly Claims Exhibit deadlines for assigned book of business.
- Conduct a final policy year-end reconciliation for all policyholders, regardless of effective date.
- Communicate to Lockton Stop Loss associates once a final policy reconciliation has been completed.
- Monitor and organize the Stop Loss and Stop Loss Reporting inboxes.
- Help identify opportunities to enhance operational efficiency and client experience within the claims process.
- Assist claims analysts by sharing knowledge and answering questions, as needed.
- Support onboarding of new analysts or claims team members by offering guidance and context.
Work Mode
This role is hybrid and based in our Plano office.
