Senior Consultant, Supplemental Health

Sun Life

Senior Consultant responsible for processing and adjudicating supplemental health insurance claims for Sun Life. Focusing on accurate, timely claims and exceptional policyholder service in a hybrid work model.

Posted 8/3/2026full-timePortland • Connecticut, Maine, Maryland, Montana • 🇺🇸 United StatesSenior💰 $71,100 - $106,700 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in supplemental health insurance claims processing, including medical coding, regulatory compliance, and effective communication with policyholders and healthcare providers. Proven ability to analyze claim information accurately and mentor team members in best practices.

Highest-signal resume keywords

Supplemental Health Insurance Claims ProcessingMedical Coding (ICD-10, CPT)Claims Management Software ProficiencyRegulatory Compliance (HIPAA, State Insurance Laws)Analytical Skills and Attention to Detail

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AdjudicationMedical TerminologyClaim EvaluationQuality Assurance ReviewsProblem-SolvingDocumentation AccuracyEligibility VerificationCoverage Details AssessmentClaims ProcessingTime Management

Soft Skills

Exceptional Customer ServiceOrganizational SkillsWritten CommunicationVerbal CommunicationCollaboration

Tools & Technologies

Claims Management SoftwareComputer Applications

Industry Keywords

Healthcare Industry RegulationsInsurance ClaimsPolicyholder InteractionClaims Team CollaborationInternal Procedures

About the role

Key responsibilities & impact

Process and adjudicate supplemental health insurance claims in accordance with company policies and regulatory guidelines
Ensure accurate and timely claim payments while providing exceptional customer service to policyholders
Review and evaluate supplemental health insurance claims for eligibility, completeness, and accuracy
Verify policy information, coverage details, and applicable endorsements or riders
Adjudicate claims using established guidelines and company policies
Determine the accuracy of medical coding, diagnostic information, and procedure documentation
Collaborate with the claims team to investigate and resolve any complex or disputed claims
Ensure that 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 any additional requirements to policyholders and healthcare providers
Perform quality assurance reviews and mentor other Claims Consultants by providing feedback and identifying development opportunities with staff and management

Requirements

What you’ll need

5+ years of experience in supplemental health insurance claims processing or medical billing
Strong knowledge of medical terminology, coding systems (e.g., ICD-10, CPT), and claim adjudication processes
Familiarity with healthcare industry regulations, including HIPAA and state insurance laws
Excellent analytical skills and attention to detail to accurately review and evaluate claim information
Proficient in using claims management software and other computer applications
Exceptional organizational and time management skills to prioritize workload and meet deadlines
Excellent written and verbal communication skills to effectively interact with policyholders, providers, and internal stakeholders
Strong problem-solving skills to resolve claim-related issues effectively and efficiently

Benefits

Comp & perks

Health insurance
401(k) matching
Generous vacation and sick time
Paid family, parental and adoption leave
Medical coverage
Company paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
Flexible work arrangements