Stop Loss & Health Claim Analyst

SunLife

Base: $54,100 - $81,200; bonus: discretionary annu...
Hybrid
3-5 years medical claims experience
Stop loss claim processing knowledge
Contractual provision application skills
This position is responsible for reviewing claims, interpreting contracts, and ensuring proper documentation for Stop Loss claim determinations

Job Summary

  • This position is responsible for reviewing claims, interpreting contracts, and ensuring proper documentation for Stop Loss claim determinations.
  • The role requires applying contractual provisions 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, 401(k) match, and a partially paid sabbatical program.

Matching Summary

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

Salary

Base: $54,100 - $81,200; Bonus: Discretionary annual incentive award based on performance; Benefits: Comprehensive package including vacation, sick time, 401(k) match, and sabbatical

Skills & Requirements

Must-have

  • 3-5 years medical claims experience
  • Stop Loss claim processing knowledge
  • Contractual provision application skills
  • HIPAA and regulatory compliance awareness
  • Microsoft Office suite proficiency

Nice-to-have

  • Strong negotiation and persuasion skills
  • Solutions-based underwriting ability
  • Fast-paced environment adaptability
  • Cooperative team relationship building
  • Professional case management resource usage

Key Requirements

  • Minimum 3-5 years first dollar medical or stop loss experience
  • Knowledge of Stop Loss industry practices preferred
  • Understanding of HIPAA, privacy, and Affordable Care Act guidelines

Work Rights

Not specified

Tailored Resume

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