Cost Containment Specialist

Cost Containment Specialist

The Cost Containment Specialist supports medical cost management across the A&H claims portfolio, with a focus on high-dollar and complex claims. This role reviews claim information, identifies potential savings opportunities, coordinates with claims teams, TPAs, and vendors, and helps ensure cost containment efforts are documented, tracked, and moved forward timely.

Responsibilities:

• Review high-dollar and complex medical claims to identify cost drivers, savings opportunities, and appropriate next steps.
• Support claims teams by reviewing medical bills, clinical information, and claim documentation for potential cost containment opportunities.
• Coordinate with TPAs and external vendors, including bill review, clinical review, specialty networks, and other cost containment partners.
• Track assigned referrals, follow up on open items, and help ensure savings opportunities are moving forward timely.
• Document claim review findings, vendor recommendations, and cost containment outcomes clearly and consistently.
• Monitor claim activity and emerging medical cost trends that may impact large loss outcomes.
• Assist with reporting on savings, referral activity, claim status, and vendor results.
• Contribute to process improvements, tools, and best practices that support effective medical cost management.

Work Experience:

Necessary Work Experience includes:

• Experience in medical cost containment, complex claims review, medical billing, or Accident & Health claims support.
• Experience reviewing medical claims and identifying cost drivers, savings opportunities, or referral needs.

Preferred Work Experience includes:

• Experience in medical stop loss, Accident & Health, or employer-sponsored health plans.
• Clinical, billing, coding, or claim review experience helpful but not required.
• Experience working with TPAs, bill review vendors, clinical review resources, or specialty cost containment solutions.

Qualifications:

Necessary Qualifications include:

• Bachelor's degree or equivalent combination of education and relevant work experience.
• Working knowledge of medical billing, coding, claim review, or cost containment practices.

Preferred Qualifications include:

• Registered Nurse (RN) or similar clinical credential.
• Experience in Accident & Health, medical stop loss, or employer-sponsored health plans.
• Understanding of medical claim review, large loss claims, and key medical cost drivers.

Compensation Package:

The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate's professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE's annual discretionary bonus plan based on business and individual performance. We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team.

QBE Benefits:

• Hybrid Working a mix of working from home and in the office
• 22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis
• Competitive 401(k) program with company match up to 8%
• Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice
• Tuition Reimbursement for professional certifications, and continuing education
• Employee Network and Community QBE actively supports six Employee Networks, and many ways to give back to your community

Why QBE? What if you could have a positive impact at work and in the world?

At QBE, we're enabling a more resilient future for our customers, communities, environment, and for our people. We're building momentum to achieve something significant and know our people are at the center of our success.

Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you'll get to spend every day working with people who are passionate, talented and kind. And our international scale means we're big enough for your ambitions, yet small enough for you to make a real impact.

Join us now, so you can be part of our success and we can be part of yours!

Commitment to Diversity

QBE is committed to providing reasonable accommodation to, among others, individuals with disabilities and disabled veterans. If you need an accommodation because of a disability to search and apply for a career opportunity with QBE, please inform our Talent Acquisition team to let us know the nature of your accommodation request and your contact information.

Equal Employment Opportunity:

QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; protected veteran status; or disability or any other legally protected status.

Skills: Administration Management, Analytical Thinking, Case Management, Claims Management, Communication, Critical Thinking, Customer Service, Decision Making, Health Care, Intentional collaboration, Managing performance, Process Refinement, Regulatory Compliance, Risk Management, Stakeholder Management

How to Apply:

To submit your application, click "Apply" and follow the step by step process.

Equal Employment Opportunity:

QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.