Stop Loss & Health Claim Analyst

Sun Life U.S.

Base: $54,100 - $81,200; bonus/equity: discretiona...
Hybrid
3-5 years first dollar medical claims experience
Stop loss claim processing knowledge
Contractual provision application skills
This position is responsible for reviewing claims, interpreting contracts, and ensuring all required documentation supports Stop Loss claim determinations

Job Summary

  • This position is responsible for reviewing claims, interpreting contracts, and ensuring all required documentation supports Stop Loss claim determinations.
  • The incumbent must apply appropriate contractual provisions and plan specifications to medical facts to decide on reimbursement or denial of claims.
  • Sun Life offers comprehensive benefits including generous vacation, paid family leave, 401(k) match, and a partially paid sabbatical program.

Matching Summary

This position is responsible for reviewing claims, interpreting contracts, and ensuring all required documentation supports Stop Loss claim determinations.

Salary

Base: $54,100 - $81,200; Bonus/Equity: Discretionary annual incentive award based on performance; Benefits: Comprehensive health, dental, vision, life insurance, 401(k) match, sabbatical program

Skills & Requirements

Must-have

  • 3-5 years first dollar medical claims experience
  • Stop Loss claim processing knowledge
  • Contractual provision application skills
  • Medical record analysis capability
  • HIPAA and regulatory compliance awareness

Nice-to-have

  • Strong negotiation and persuasion skills
  • Solutions-based underwriting success
  • Fast-paced environment adaptability
  • Microsoft Office suite proficiency
  • Cooperative team relationship building

Key Requirements

  • Minimum 3-5 years experience in medical or stop loss claims
  • Knowledge of Stop Loss industry practices preferred
  • Understanding of legal risk and regulatory guidelines

Work Rights

Not specified

Tailored Resume

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