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Lockton · 4 days ago

Sr. Claims Specialist

Plano, TX

Full-time

Hybrid

Senior Level

Lockton is a leading insurance brokerage firm, and they are seeking a Senior Claims Specialist to manage the full lifecycle of stop loss claim submissions. The role involves ensuring accuracy and quality in the claims process while serving as a trusted partner to clients and internal stakeholders.

Auto InsuranceInsuranceRisk Management

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

Ensures that all claim submissions meet quality control standards and internal documentation policies

Meets monthly Claims Exhibit deadlines for assigned book of business

Conducts a final policy year-end reconciliation for all policyholders, regardless of effective date

Communicates to Lockton Stop Loss associates once a final policy reconciliation has been completed

Monitors and organizes the Stop Loss and Stop Loss Reporting inboxes

Helps identify opportunities to enhance operational efficiency and client experience within the claims process

Assists claims analysts by sharing knowledge and answering questions, as needed

Supports onboarding of new analysts or claims team members by offering guidance and context

Qualification

Claims managementData analysisSubmission trackingQuality controlDocumentation policiesOperational efficiencyClient communicationReimbursement processingClaims reportingPolicy reconciliationStop Loss expertiseProblem-solvingAttention to detailProactive communicationTeam collaborationIndependenceOrganizational skillsClient-focused

Required