Stop Loss & Health Claim Analyst
Sun Life
full-time
Posted on:
Location Type: Office
Location: Hartford • Connecticut, Maine, Maryland, Massachusetts, Montana • 🇺🇸 United States
Visit company websiteSalary
💰 $54,900 - $82,400 per year
Job Level
Mid-LevelSenior
About the role
- responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination
- responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims
- applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim
- accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources
Requirements
- Bachelor's degree preferred
- A minimum of three to five years’ experience processing first dollar medical claims or stop loss claim processing
- Demonstrated ability to work as part of a cohesive team
- Strong written and verbal communication skills
- Knowledge of Stop Loss Claims and Stop Loss industry preferred
- Demonstrated success in negotiation, persuasion, and solutions-based underwriting
- Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
- Overall knowledge of health care industry
- Proficiency using the Microsoft Office suite of products
- Ability to travel
Benefits
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
Stop Loss claim processingfirst dollar medical claims processingclaims practicesclaims proceduresclaims protocolscontractual provisionsplan specificationscase management
Soft skills
teamworkwritten communicationverbal communicationnegotiationpersuasionsolutions-based underwritingflexibilityprofessionalism