Cost Containment Manager

Cost Containment Manager

• Location: USA Multi Office Locations

• Work Arrangement: Hybridif within 50 miles from office location

• The salary range for this role is:$133500-$251000K

The Opportunity

The purpose of this role is to support medical cost management across the A&H claims portfolio with a focus on high-dollar and complex claims. The Cost Containment Manager partners with claims underwriting and vendors to identify savings opportunities provide guidance on claim strategy and help maintain consistent effective cost containment practices.

Your Responsibilities:

• Review high-dollar and complex medical claims to identify cost drivers savings opportunities and appropriate review strategies
• Provide experienced guidance to claims teams on bill review clinical considerations and cost containment approach on large and complex cases
• Partner with claims and underwriting to support large loss review risk assessment and renewal insights tied to medical cost trends
• Work closely with TPAs and external vendors (e.g. bill review clinical specialty networks) to support strong claim and financial outcomes
• Evaluate vendor performance on assigned claims and help ensure value is being realized from cost containment solutions
• Monitor claim activity and emerging trends that may impact medical costs and identify opportunities for improved outcomes
• Support consistent application of cost containment practices across the portfolio particularly on high-exposure claims
• Contribute to development and refinement of best practices tools and training that enhance overall cost management effectiveness
• Stay current on market regulatory and clinical developments impacting medical costs and cost containment strategies

• Deliver measurable impact through identification and execution of savings opportunities on complex and high-cost claims

Work Experience:

Necessary Work Experience includes:

• Extensive experience in medical cost containment complex claims management or Accident & Health risk management
• Demonstrated experience reviewing high-dollar claims and identifying cost drivers and savings opportunities

Preferred Work Experience includes:

• Experience in medical stop loss risk management
• Strong clinical background with hands-on experience interpreting medical records and billing practices
• Experience working with TPAs bill review vendors and specialty cost containment solutions

Qualifications:

Necessary Qualifications include:

• Bachelors degree or equivalent combination of education and relevant work experience
• Strong knowledge of medical billing coding and 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
• Advanced understanding of medical claim review large loss management and cost drivers

Compensation Package: 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 roles complexity its location and the candidates professional background including their education and experience. Beyond the base salary regular full-time and part-time employees will also be eligible for QBEs annual discretionary bonus plan based on business and individual 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.

QBE Benefits: 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 Reimbursement for professional certifications and continuing education

• Employee Network and Community QBE actively supports six Employee Networks and many ways to give back to your community

To learn more click here: Benefits QBE US.

Why QBE What if you could have a positive impact at work and in the world

At QBE were enabling a more resilient future for our customers communities environment and for our people. Were building momentum to achieve something significant and know our people are at the center of our success.

Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team youll get to spend every day working with people who are passionate talented and kind. And our international scale means were big enough for your ambitions yet small enough for you to make a real impact.

Join us now so you can be part of our success and we can be part of yours!

to Diversity

QBE is committed to providing reasonable accommodation to among others individuals with disabilities and disabled veterans. If you need an accommodation because of a disability to search and apply for a career opportunity with QBE please inform our Talent Acquisition team to let us know the nature of your accommodation request and your contact information.

Equal Employment Opportunity:

QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy childbirth or related medical conditions; protected veteran status; or disability or any other legally protected status.

Supplementary information

Skills:

How to Apply:

To submit your application click Apply and follow the step by step process.

Equal Employment Opportunity:

QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.