Senior Manager, Insurance and Claims Advocacy

Pinnacle Building Services, Inc

Senior Manager leading a claims advocacy team at Sun Life U.S. to navigate and resolve complex medical billing issues.

Posted 6/18/2026full-timeBaltimore • Connecticut, Maine, Maryland, Massachusetts, Montana • 🇺🇸 United StatesSenior💰 $76,200 - $114,300 per yearWebsite

ATS Keywords

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Hard Skills

medical billingclaims advocacycomplex claims resolutionappealscoordination of benefitsinsurance plan analysispayer claims adjudicationCPT codingICD codingprovider billing practices

Soft Skills

people leadershipnegotiationescalation managementprocess improvementcommunicationinfluence

Tools & Technologies

SalesforceMS Officedata analyticsAI-enabled tools

Certifications & Qualifications

Bachelor's degreeadvanced degreerelevant certification

Industry Keywords

insurance navigationclaims resolutionservice delivery standardskey performance indicatorsaudit-ready documentationSOPsregulationsquality standardscross-functional collaborationmember experience

About the role

Key responsibilities & impact

Lead and develop a high-performing Insurance and Claims Advocacy team
Own program strategy, service delivery standards, and key performance indicators across insurance navigation and claims resolution
Oversee resolution of complex medical billing and insurance issues
Guide proactive insurance navigation
Build and optimize scalable workflows
Ensure accurate, audit-ready documentation and adherence to SOPs, regulations, and quality standards
Partner cross-functionally to implement improvements, support growth, and elevate the member experience

Requirements

What you’ll need

7+ years of experience in medical billing/claims advocacy, complex claims resolution, appeals, coordination of benefits, and insurance plan analysis
Bachelor’s degree in healthcare administration, business, or related field required; advanced degree and/or relevant certification preferred
3+ years of progressive people leadership experience
Deep knowledge of payer claims adjudication, CPT/ICD coding, and provider billing practices
Strong negotiation and escalation management skills
Proven ability to drive process improvement using data/analytics, technology platforms (e.g., Salesforce, MS Office), and responsible AI-enabled tools
Excellent communication skills and ability to influence cross-functional stakeholders

Benefits

Comp & perks

Generous vacation and sick time
Market-leading paid family, parental, and adoption leave
Medical coverage
Company paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
401(k) employer match
Stock purchase options
Employer-funded retirement account
Flexible, inclusive, and collaborative work environment