Cost Containment Manager

Primary Details: Time Type: Full time. Worker Type: Employee. Location: USA – Multi Office Locations. Work Arrangement: Hybrid if within 50 miles of office. Salary range: $133,500 - $251,000K. Opportunity The purpose of this role is to support medical cost management across the A&H claims portfolio, with a focus on high-dollar and complex claims. The Cost Containment Manager partners with claims, underwriting, and vendors to identify savings opportunities, provide guidance on claim strategy, and help maintain consistent, effective cost containment practices. Responsibilities Review high-dollar and complex medical claims to identify cost drivers, savings opportunities, and appropriate review strategies. Provide experienced guidance to claims teams on bill review, clinical considerations, and cost containment approach on large and complex cases. Partner with claims and underwriting to support large loss review, risk assessment, and renewal insights tied to medical cost trends. Work closely with TPAs and external vendors (e.g., bill review, clinical, specialty networks) to support strong claim and financial outcomes. Evaluate vendor performance on assigned claims and help ensure value is being realized from cost containment solutions. Monitor claim activity and emerging trends that may impact medical costs and identify opportunities for improved outcomes. Support consistent application of cost containment practices across the portfolio, particularly on high-exposure claims. Contribute to development and refinement of best practices, tools, and training that enhance overall cost management effectiveness. Stay current on market, regulatory, and clinical developments impacting medical costs and cost containment strategies. Deliver measurable impact through identification and execution of savings opportunities on complex and high-cost claims. Required Experience Extensive experience in medical cost containment, complex claims management, or Accident & Health risk management. Demonstrated experience reviewing high-dollar claims and identifying cost drivers and savings opportunities. Preferred Experience Experience in medical stop loss risk management. Strong clinical background with hands‑on experience interpreting medical records and billing practices. Experience working with TPAs, bill review vendors, and specialty cost containment solutions. Required Qualifications Bachelor’s degree or equivalent combination of education and relevant work experience. Strong knowledge of medical billing, coding, and cost containment practices. Preferred Qualifications Registered Nurse (RN) or similar clinical credential. Experience in Accident & Health, medical stop loss, or employer-sponsored health plans. Advanced understanding of medical claim review, large loss management, and cost drivers. Compensation & 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 – active support for employee networks and community giving. Equal Employment Opportunity QBE is committed to providing 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, disability or any other legally protected status. #J-18808-Ljbffr