What are the responsibilities and job description for the Sr. Claims Specialist - Stop Loss position at Lockton?
Your Responsibilities
Preferred location: Plano but open to remote
- 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
Preferred location: Plano but open to remote