Job Summary:

Lockton Dunning Benefits is currently seeking a Senior Claims Analyst responsible claims resolution by partnering with internal clinical staff, vendors and insured clients. The ideal candidate will demonstrate a high level of professionalism; possess the ability to work well in a fast-paced environment and the flexibility to easily adapt to changing priorities.

• Participate in discussions on strategic planning for specialized claims resolution that helps to drive better insured care and cost savings
• Collaborate with internal Clinical Team to review high claim projections and identify overall risk tolerance
• Develop financial models and reports for client service team, provides interpretation and implication of recommended alternatives
• Serve as subject matter expert to Claims Analysts, managing escalations and providing training and support
• Establish timelines for client deliverables and oversee process to ensure deadlines are met
• Collaborate with team to ensure proper review of all agreements and/or documents
• Works with Service Team and Internal Legal Counsel on compliance issues
• Create and manage reporting tools to identify variances and potential high risk claims to proactively address opportunities to reduce medical costs
• Work directly with Service Delivery Team to recommend specific client solutions/options on high claims
• Assist in developing an implementation plan and managing deliverable timelines to ensure they are met
• Interpret clients’ current coverages and identifies/recommends gaps, alternatives, additional plan design changes, etc.
• Present Service Teams and Clinical Team with findings on a) large claims b) abnormal utilization results c) monthly claims experience d) set strategies and goals and e) if needed conduct on-site claims visits
• Address outstanding issues and claims matters with clients, carriers and administrators
• Research and understand industry trends and carrier product offerings
• Maintain knowledge of governmental compliance and regulations to educate and consult client(s)
• Other responsibilities as assigned and/or needed

Requirements:

• Bachelor's degree in Business related field and/or equivalent years of experience
• A minimum of 3 years' experience in the insurance industry, specifically in medical, high cost claims
• Strong knowledge of differing financial arrangements and products available to clients (i.e. fully insured, self-insured, minimum premium, ASO)
• Strong analytical skills and experience with creating actionable solutions
• Strong working knowledge and understanding of medical billing, claims processing and collections rules and regulations
• Strong knowledge of Microsoft Office Suite (Word, Outlook, Excel, and PowerPoint)
• Excellent organizational, communication and time management skills
• Legal right to work in the United States

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