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Lockton · 6 hours ago

Complex Claims Specialist

Minneapolis, MN

Full-time

Onsite

Senior Level

5+ years exp

Lockton is currently seeking a Clinical Claims Specialist within our Specialty Practice unit. The objective of this role is to improve and reduce the severity of complex and catastrophic claims while enhancing the health of employer clients' employee health plans.

Auto InsuranceInsuranceRisk Management

Responsibilities

Provide explanation of disease states and associated costs to internal and external stakeholders

Provide cost-of-care estimates used in the risk assessment of stop loss underwriting

Consult with and advise underwriting on medical/clinical care approaches, standards of care and research of data for new business and renewals

Serve as a resource regarding medical necessity issues, standards of care and analysis for the reimbursement of submitted stop loss claims

Review claims and clinical documents to identify and monitor opportunities to increase member quality of care and overall cost reduction

Collaborate with various key stake holders to strategize clinical and cost savings strategies and assist on execution of plan

Coordinate implementation of claims savings solutions with Lockton Client Service Teams, TPAs, and stop loss carriers including regular tracking to measure savings and plan performance

Manage and organize task lists and open items and cases

Attend team clinical rounds to discuss cases and strategy solutions

Qualification

RN LicensureClinical Risk ManagementHealth Insurance ProcessesCCM CertificationQuality ManagementAnalytical SkillsMicrosoft ProductsTime ManagementOrganizational SkillsCommunication Skills