Sr. Claims Specialist - Stop Loss

Your Responsibilities

• Responsible for managing the full lifecycle of stop loss claim submissions with minimal oversight.
• Serves as a trusted partner to clients, carriers, and internal stakeholders, ensuring accuracy, timeliness, and quality in the claims process.
• Acts as a subject matter resource within the team, operating independently to resolve routine issues and ensure seamless execution.
• Manages end-to-end submission and tracking of stop loss claims, focusing 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 ensures proper follow-through until reimbursement is received.
• Identifies and resolves discrepancies or delays directly with carrier contacts, requiring little to no escalation.
• Serves 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.
• Mets 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.
• Maintains 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

Qualifications

Preferred location: Plano but open to remote

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Equal Opportunity Statement

Lockton Companies is proud to provide everyone an equal opportunity to grow and advance. We are committed to an inclusive culture and environment where our people, clients and communities are treated with respect and dignity.

About Lockton

Lockton is the largest privately held independent insurance brokerage in the world. Since 1966, our independence has allowed us to serve our clients, take care of our people and give back to our communities. As such, our 13,100+ Associates doing business in over 155 countries are empowered to do what’s right every day.

At Lockton, we believe in the power of all people. You belong at Lockton.

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