Sr. Claims Specialist

Lockton•Plano, TX

39d

About The Position

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

Responsibilities

Managing the full lifecycle of stop loss claim submissions
Ensuring accuracy, timeliness, and quality in the claims process
Managing end-to-end submission and tracking of stop loss claims
Interpreting and analyzing claim data, eligibility documents, EOBs, and carrier-specific requirements
Submitting claims to carriers and ensure proper follow-through until reimbursement is received
Identifying and resolving discrepancies or delays directly with carrier contacts
Serving as a point of contact for claims-related questions
Proactively communicating with carriers to troubleshoot processing issues
Keeping stakeholders informed of claim statuses, outstanding documentation, and anticipated turnaround times
Maintaining detailed and organized claim records, logs, and audit trails
Supporting reporting efforts related to claim volumes, reimbursement trends, and turnaround times
Ensuring that all claim submissions meet quality control standards and internal documentation policies
Meeting monthly Claims Exhibit deadlines for assigned book of business
Conducting a final policy year-end reconciliation for all policyholders
Communicating to Lockton Stop Loss associates once a final policy reconciliation has been completed
Monitoring and organizing the Stop Loss and Stop Loss Reporting inboxes
Helping identify opportunities to enhance operational efficiency and client experience within the claims process
Assisting claims analysts by sharing knowledge and answering questions, as needed
Supporting onboarding of new analysts or claims team members by offering guidance and context