Complex Claims Coordinator

6 days ago


Minneapolis, Minnesota, United States Lockton Full time

Description
Your Responsibilities
Lockton is currently seeking a Complex Claims Coordinator within our Specialty Practice unit. The objective of this role is to improve and reduce the severity of complex and catastrophic claims, reduce the cost of risk while improving the health of our employer client's employee health plan.

  • Provide explanation of disease states and associated costs to internal and external stakeholders.
  • Provide cost-of-care estimates used in the risk assessment of stop loss underwriting.
  • Consult with and advise underwriting on medical/clinical care approaches, standards of care and research of data for new business and renewals.
  • Serve as a resource regarding medical necessity issues, standards of care and analysis for the reimbursement of submitted stop loss claims.
  • Review claims and clinical documents to identify and monitor opportunities to increase member quality of care and overall cost reduction.
  • Collaborate with various key stake holders to strategize clinical and cost savings strategies and assist on execution of plan.
  • Coordinate implementation of claims savings solutions with Lockton Client Service Teams, TPAs, and stop loss carriers including regular tracking to measure savings and plan performance.
  • Manage and organize task lists and open items and cases.
  • Attend team clinical rounds to discuss cases and strategy solutions.

Qualifications
Qualifications

  • Licensure as a RN or Bachelor's in Healthcare Management or related field (preferred).
  • A minimum of 2 years of clinical/risk management experience (preferred).
  • Experience and/or knowledge of health insurance processes.
  • CCM, NANCM, or other certification or designation is a plus.
  • Working knowledge or experience in quality and care management.
  • Proven time management experience.
  • Strong organizational skills with ability to handle multiple tasks, in a fast-paced environment.
  • Excellent oral and written communication skills.
  • Ability to translate complex clinical topics and subjects to a non-clinical audience.
  • Demonstrated advanced analytical and problem-solving skills.
  • Working knowledge of Microsoft products (Word, Outlook, PowerPoint)


  • Minneapolis, Minnesota, United States Lockton Companies Full time

    Working at LocktonAt Lockton, we're passionate about helping our people achieve their ultimate potential. Our people are curious, action-oriented and always striving to make ourselves and those around us better. We're active listeners working to ensure understanding and problem solvers developing innovative solutions. If you can see yourself delivering...


  • Minneapolis, Minnesota, United States American Family Insurance Full time $56,000 - $92,000

    Investigates and maintains property claims. Reviews and determines coverage, secures information, arranges appraisals, and settles claims. You will report to a Property Claims Manager.In this primarily home-based role, you will spend 80% of your time (4+ days per week) working from home, proximate to one of our office locations- Madison, WI, Boston, MA,...


  • Minneapolis, Minnesota, United States Holmes Murphy Insurance Full time $75,500 - $125,800

    Job Description:Are you looking for an opportunity to leverage your knowledge and knowledge and experience to help clients improve their claim process and outcomes? Do you enjoy helping clients and solving problems? If that sounds like you, consider joining our team We are looking to add a Sr. Claims Consultant to join our Property & Casualty Construction...


  • Minneapolis, Minnesota, United States Western National Insurance Group Full time

    :Who are we?Western National Insurance Group is a private mutual insurance company with over 120 years of experience serving customers' property-and-casualty insurance needs in the Midwestern, Northwestern, and Southwestern United States. Known as "The Relationship Company," we define success as a measure of the relationships we've built over time. In...


  • Minneapolis, Minnesota, United States Western National Group & Umialik Insurance Full time

    Full-time Description Who are we?Western National Insurance Group is a private mutual insurance company with over 120 years of experience serving customers' property-and-casualty insurance needs in the Midwestern, Northwestern, and Southwestern United States. Known as "The Relationship Company," we define success as a measure of the relationships we've built...


  • Minneapolis, Minnesota, United States RBC Full time

    Job DescriptionWhat is the opportunity?This role will provide temporary backup support for primary supervisory positions (e.g., Complex Assistant Manager, Complex Operations Manager, Sr. Branch Service Manager, etc.) during their extended leave absences (e.g., 4–6 months). As a contingency resource, you will maintain operational continuity by executing...


  • Minneapolis, Minnesota, United States RBC Full time $85,000 - $150,000

    Job DescriptionWhat is the opportunity?This role will provide temporary backup support for primary supervisory positions (e.g., Complex Assistant Manager, Complex Operations Manager, Sr. Branch Service Manager, etc.) during their extended leave absences (e.g., 4–6 months). As a contingency resource, you will maintain operational continuity by executing...


  • Minneapolis, Minnesota, United States Ultimate Staffing Full time

    Customer Support Coordinator - Medical DeviceAbout the RoleThe Customer Support Coordinator - Medical Device plays a key role in supporting medical device logistics, healthcare equipment returns, and field device recovery operations. This position is responsible for coordinating, planning, and managing the retrieval, return, and recovery of medical devices...


  • Minneapolis, Minnesota, United States Lockton Full time

    Your ResponsibilitiesMonitors claims activities and results, facilitating the resolutions of claims as neededFunctions as liaison between Clients and insurance carriers, advocating for the best outcome for the Client while respecting Insurance CarrierEnsures the accuracy and completeness of claim formsReviews claim status, action plans, and reserves by...


  • Minneapolis, Minnesota, United States Ebenezer Full time

    Job Overview:We are looking for a Financial Case Coordinator - Tranplant to join our team As a member of the transplant team, the Transplant Financial Case Coordinator manages and/or coordinates all financial issues with patients, insurers, referring and attending physicians, nurse coordinators, social workers and other stakeholders.This case coordinator...