Stop Loss & Health Claim Analyst
Sun Life
full-time
Posted on:
Location Type: Hybrid
Location: Connecticut • Maine • United States
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Salary
💰 $54,100 - $81,200 per year
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 that supports career growth
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Stop Loss claim processingfirst dollar medical claims processingclaims practicesclaims proceduresclaims protocolsnegotiationpersuasionsolutions-based underwriting
Soft Skills
teamworkwritten communicationverbal communicationflexibilityprofessionalism
Certifications
Bachelor's degree