Three to five years experience processing first dollar medical claims
Stop loss claim processing knowledge
Ability to apply contractual provisions to medical facts
This position is responsible for reviewing claims, interpreting contracts, and ensuring all claims contain required documentation to support Stop Loss claim determinations
Job Summary
This position is responsible for reviewing claims, interpreting contracts, and ensuring all claims contain required documentation to support Stop Loss claim determinations.
The incumbent must apply appropriate contractual provisions and plan specifications to medical facts to decide on reimbursement or denial while maintaining departmental production metrics.
Sun Life offers comprehensive benefits including generous vacation, paid family leave, market-leading parental leave, and a partially paid sabbatical program.
Matching Summary
This position is responsible for reviewing claims, interpreting contracts, and ensuring all claims contain required documentation to support Stop Loss claim determinations.
Salary
Base: $54,100 - $81,200; Bonus/Equity: Discretionary annual incentive award based on performance; Benefits: Comprehensive package including 401(k) match and paid leave
Skills & Requirements
Must-have
Three to five years experience processing first dollar medical claims
Stop Loss claim processing knowledge
Ability to apply contractual provisions to medical facts
Strong written and verbal communication skills
Proficiency using Microsoft Office suite
Nice-to-have
Knowledge of Stop Loss industry preferred
Success in negotiation and persuasion
Solutions-based underwriting ability
Awareness of industry claim practices
Cooperative relationship building with professional resources
Key Requirements
Minimum 3-5 years experience in first dollar medical or stop loss claims
Knowledge of HIPAA, privacy, and Affordable Health Care Act regulations
Demonstrated success in negotiation and solutions-based underwriting