Job Description
At 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 excellent service to clients, giving back to our communities and being a part of our caring culture, you belong here.
Lockton is currently seeking a Custom Clinical Specialist within its Advanced Medical Advisory Practice. The objective of this role is to provide complex claims management with the focus of identifying opportunities and working collaboratively with key stakeholders to reduce the severity of catastrophic claims while improving the quality of care for client health plan members. Clients include large commercial health plans and employers requiring a high touch approach with both reviews and client interaction and engagement.
- Review client’s medical and pharmacy claims data to identify opportunities to improve quality of care, enhance health outcomes, improve member experience and/or reduce cost of care.
- Review escalated and complex cases to identify and monitor opportunities.
- Actively participate in client strategy meetings to discuss high-cost member outlook and potential intervention opportunities.
- Interpret and articulate clinical findings to tell the story of the member’s health care journey and the impact of interventions recommended to the client.
- Explain disease states and associated costs to internal teams and external clients.
- Validate cost-of-care estimates used in the risk assessment of stop loss underwriting.
- Consult and advise on medical/clinical care approaches.
- Serve as a subject matter expert regarding medical necessity issues, current standards of care and analysis for reimbursement of submitted stop loss claims.
- Serve in a leadership role for assigned clients.
- Lead client and stakeholder calls to review case level details.
- Ensure productivity meets practice needs.
- Execute opportunities agreed upon with clients and continue to follow up until completion.
Qualifications • Licensure as a RN or Bachelor’s in Healthcare Management or related field.
- CCM, CPC or other certification or designation is a plus.
- 5+ years of clinical/risk management experience.
- 2+ years of claims and/or utilization review experience.
- Experience in health care costs and benchmarking.
- Working knowledge or experience in quality and care management.
- Knowledge of health insurance processes.
- Understanding of claim coding and processing, including CPT and ICD-10 coding.
- Ability to translate complex clinical topics and subjects to a non-clinical audience.
- Effective communication, presentation and negotiation skills.
- Demonstrated advanced analytical and problem-solving skills.
- Ability to work collaboratively with all levels of an organization in a dynamic and fast-paced environment.
- Proven record of accomplishment for managing multiple competing priorities.
- Strong organizational and time management skills with ability to handle multiple tasks simultaneously.
- Working knowledge of Microsoft products (Word, Outlook, PowerPoint, Excel).
- Ability to travel on an as needed basis.
- Legal right to work in the United States.
Equal Opportunity Statement Lockton Companies is proud to provide everyone anequal 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.
At Lockton, supporting diversity, equity and inclusion is ingrained in our values, and we believe that we are at our best when we fully embrace everyone. We strive to cultivate a caring culture that learnsfrom, celebrates and thrives because of ourbreadth of differences. As such, we recognize that recruiting, developing and retaining people with diverse backgrounds and experiences is vital and enabling our people to thrive personally and professionally is critical to our long-term success.
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 12,500+ Associates doing business in over 140 countries are empowered to do what’s right every day.
At Lockton, we believe in the power of all people. You belong at Lockton.
How We Will Support You At Lockton, we empower you to be true to yourself in all that you do. Your success is our success, and we provide opportunities to help you grow and create a rewarding career path, however you envision it.
We are ready to meet you where you are today, and as your needs change over time. In addition to industry-leading health insurance, we offer additional options to support your overall health and wellbeing.
Any Employment Agency, person or entity that submits an unsolicited resume to this site does so with the understanding that the applicant's resume will become the property of Lockton Companies, Inc. Lockton Companies will have the right to hire that applicant at its discretion and without any fee owed to the submitting Employment Agency, person or entity. Employment Agencies, who have fee Agreements with Lockton Companies must submit applicants to the designated Lockton Companies Employment Coordinator to be eligible for placement fees.
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