Senior Manager, Insurance and Claims Advocacy

Sun Life

Senior Manager leading Insurance and Claims Advocacy team for Sun Life U.S. Overseeing complex claims resolution and enhancing member experience in healthcare insurance.

Posted 5/23/2026full-timeBaltimore • Connecticut, Maine, Maryland, Massachusetts, Montana • 🇺🇸 United StatesSenior💰 $76,200 - $114,300 per yearWebsite

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 (denials and appeals, billing errors/coding discrepancies, out-of-network disputes)
Guide proactive insurance navigation, including benefits education, coverage guidance, and pre-service support to remove barriers and improve member outcomes.
Build and optimize scalable workflows, leveraging data, technology platforms, and responsible AI-enabled tools to improve quality, efficiency, and turnaround time.
Ensure accurate, audit-ready documentation and adherence to SOPs, regulations, and quality standards.
Partner cross-functionally (Sales, Client Service, Member Services, Analytics, and clinical teams) 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, with demonstrated success managing teams and service operations
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 in a fast-paced environment.

Benefits

Comp & perks

Health insurance
401(k) employer match
Paid vacation and sick time
Paid family, parental and adoption leave
Disability programs
Employer-funded retirement account
Partially paid sabbatical program
Flexible work arrangements

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical billingclaims advocacycomplex claims resolutionappealscoordination of benefitsinsurance plan analysisCPT codingICD codingprovider billing practicesprocess improvement

Soft Skills

people leadershipnegotiationescalation managementcommunicationinfluencecross-functional collaborationteam managementservice operationsproblem-solvingmember outcomes improvement

Certifications

Bachelor’s degree in healthcare administrationBachelor’s degree in businessadvanced degreerelevant certification