Sr. Claims Specialist - Stop Loss

Job Summary:

• 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

Requirements:

Preferred location: Plano but open to remote

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