Stop Loss & Health Claim Analyst
Sun Life
full-time
Posted on:
Location Type: Hybrid
Location: Hartford • Connecticut • Maine • United States
Visit company websiteExplore more
Salary
💰 $54,100 - $81,200 per year
About the role
- Review claims and interpret contracts
- Disperse reimbursement and ensure claims have required documentation
- Provide customer service and manage financial risk for Stop Loss claims
- Apply appropriate contractual provisions and plan specifications
- Maintain claim block and meet departmental production and quality metrics
- Prepare written rationale for claim decisions based on contractual provisions and medical records analysis
- Establish relationships with professional resources and understand legal risks
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
Benefits
- Health insurance
- Generous vacation and sick time
- Market-leading paid family, parental and adoption leave
- 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 & Tools
claims processingStop Loss claimscontract interpretationmedical records analysisnegotiationpersuasionsolutions-based underwriting
Soft Skills
customer serviceteamworkwritten communicationverbal communicationflexibilityprofessionalism
Certifications
Bachelor's degree