Associate Business Consultant – Life Sciences Commercial
Veeva Systems
Senior Consultant, Supplemental Health
Sun Life
full-time
Posted on:
Location Type: Hybrid
Location: Portland • Connecticut, Maine, Maryland, Massachusetts, Montana • 🇺🇸 United States
Visit company websiteSalary
💰 $71,100 - $106,700 per year
Job Level
Senior
About the role
- Review and evaluate supplemental health insurance claims for eligibility, completeness, and accuracy
- Verify policy information, coverage details, and any applicable endorsements or riders
- Adjudicate claims using established guidelines and company policies
- Determine the accuracy of medical coding, diagnostic information, and procedure documentation
- Request additional information or documentation from policyholders or healthcare providers
- Collaborate with the claims team to investigate and resolve complex or disputed claims
- Ensure claims are processed and paid in compliance with industry regulations and internal procedures
- Update claim status and maintain detailed and accurate records of all claim activities
- Communicate claim decisions, payment details, and additional requirements to policyholders and providers
- Respond to inquiries and provide exceptional customer service to resolve claim-related issues
- Perform quality assurance reviews and mentor other Claims Consultants
- Evaluate current processes for efficiency and effectiveness and provide manager support
Requirements
- 5+ years of experience in supplemental health insurance claims processing or medical billing
- Strong knowledge of medical terminology
- Knowledge of coding systems (ICD-10, CPT)
- Experience with claim adjudication processes
- Familiarity with healthcare industry regulations including HIPAA and state insurance laws
- Proficient in using claims management software and other computer applications
- Excellent analytical skills and attention to detail
- Exceptional organizational and time management skills
- Excellent written and verbal communication skills
- Ability to work independently and as part of a team
- Strong problem-solving skills
- Ability to attain and maintain appropriate TPA licenses in accordance with the Claims Licensing Policy
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
- Discretionary annual incentive award based on individual and business performance
- Flexible, inclusive and collaborative work environment
- Recognition programs and career growth opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims processingmedical billingmedical terminologyICD-10CPTclaim adjudicationclaims management softwareanalytical skillsattention to detailproblem-solving
Soft skills
organizational skillstime managementwritten communicationverbal communicationteamworkindependencecustomer servicementoring
Certifications
TPA licenses
