Cost Containment Specialist

Primary Details

Time Type:
Full time Worker Type:
Employee

• Location:
  
  USA – Marblehead or Remote Anywhere
• Work Arrangement:
  Hybrid / Remote (Based on location)
• The salary range for this role is: $ 98,.00

The Cost Containment Specialist supports medical cost management across the A&H claims portfolio, with a focus on high-dollar and complex claims. This role reviews claim information, identifies potential savings opportunities, coordinates with claims teams, TPAs, and vendors, and helps ensure cost containment efforts are documented, tracked, and moved forward timely.

• Review high-dollar and complex medical claims to identify cost drivers, savings opportunities, and appropriate next steps.
• Support claims teams by reviewing medical bills, clinical information, and claim documentation for potential cost containment opportunities.
• Coordinate with TPAs and external vendors, including bill review, clinical review, specialty networks, and other cost containment partners.
• Track assigned referrals, follow up on open items, and help ensure savings opportunities are moving forward timely.
• Document claim review findings, vendor recommendations, and cost containment outcomes clearly and consistently.
• Monitor claim activity and emerging medical cost trends that may impact large loss outcomes.
• Assist with reporting on savings, referral activity, claim status, and vendor results.
• Contribute to process improvements, tools, and best practices that support effective medical cost management.

Necessary Work Experience includes:

• Experience in medical cost containment, complex claims review, medical billing, or Accident & Health claims support.
• Experience reviewing medical claims and identifying cost drivers, savings opportunities, or referral needs.

Preferred Work Experience includes:

• Experience in medical stop loss, Accident & Health, or employer-sponsored health plans.
• Clinical, billing, coding, or claim review experience helpful but not required.

Experience working with TPAs, bill review vendors, clinical review resources, or specialty cost containment solutions.

Necessary Qualifications include:

• Bachelor’s degree or equivalent combination of education and relevant work experience.
• Working knowledge of medical billing, coding, claim review, or cost containment practices.

Preferred Qualifications include:

• Registered Nurse (RN) or similar clinical credential.
• Experience in Accident & Health, medical stop loss, or employer-sponsored health plans.
• Understanding of medical claim review, large loss claims, and key medical cost drivers.

The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate’s professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE’s annual discretionary bonus plan based on business and individual performance.

We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team.

We offer a range of benefits to help provide holistic support for your work life, whatever your circumstances. As a QBE employee you will have access to:

• 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…