Stop Loss Claims Resolution Consultant

Sun Life

Stop Loss Claims Resolution Consultant specializing in complex medical claims for major U.S. benefits provider.

Posted 7/9/2026full-timeKansas City • Connecticut, Kansas, Maine, Maryland, Massachusetts, Montana • 🇺🇸 United StatesMid-LevelSenior💰 $54,100 - $81,200 per yearWebsite

About the role

Key responsibilities & impact

Serve as an expert resource for Stop Loss medical claims
Research and resolve advanced claim inquiries
Interpret and apply contractual language consistently
Provide consultative guidance to requestors on claim status and required documentation
Own inquiries from intake through closure, ensuring accountability
Deliver clear, concise, and customer-appropriate written communication
Identify inquiries that require adjudication or reimbursement review and route to appropriate Claims Analysts
Document research, decisions, communications, and handoffs thoroughly in the system of record
Ensure all claim handling complies with privacy, security, and regulatory requirements

Requirements

What you’ll need

Expert-level knowledge of Stop Loss medical claims
3–5+ years of experience in medical claims processing and/or stop loss claims
Strong ability to interpret and explain plan documents and contract provisions
Demonstrated experience navigating claims systems, reporting, and internal knowledge resources
Experience reviewing and supporting complex or large loss stop loss claims end-to-end
Experience supporting TPAs, brokers, employers, or sales partners in a consultative or service-based role
Familiarity with overpayment concepts
Advanced analytical and problem-solving skills
Strong organizational skills with the ability to manage multiple priorities

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Medical Claims ProcessingStop Loss ClaimsClaims Systems NavigationContract InterpretationDocumentation ManagementAdjudication ReviewOverpayment ConceptsReportingConsultative GuidanceClaims Inquiry Resolution

Soft Skills

Strong Organizational SkillsClear Written CommunicationAbility To Manage Multiple Priorities