Claims Analyst, Health and Risk Solutions - Wellesley, United States - Sun Life

Description

Job Description

: At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you'll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America. The opportunity: As the leading independent stop loss carrier in the United States, Sun Life is seeking exceptional candidates to join our claims team. Stop Loss Claims Analysts are accountable for evaluating claims received, ensuring they are reimbursed correctly and all cost containment opportunities are identified by engaging the clinical team prior to adjudicating a reimbursement. Providing our clients with outstanding customer service. How you will contribute:

You will own a block of Stop Loss claims and the customer support for your block. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim.

Determine on a timely basis, the eligibility of assigned claims

Apply appropriate contractual provisions from the underlying policyholder plan, as well as the Sun Life contract, especially with regard to eligibility and exclusions

Understand where, when and how resources (both internal and external), e.g. medical, investigative and legal can add value to the process

Prepare written rationale of claim resolution based on review of the contract, plan document and the evaluation of medical records

Maintain block of business and meet departmental metrics

Establish cooperative and productive relationships with internal and external business partners

What you will bring with you :

Ability to work with a diverse range of people

Stop Loss Claims and the Stop Loss Insurance industry knowledge

3+ years of experience processing medical claims

Proficiency using MS Office suite

Bachelors degree or equivalent business experience

Overall knowledge of the U.S health care industry, including regulatory/statutory guidelines, HIPAA, privacy and the Affordable Health Care Act, as well as a working knowledge of medical terminology and coding (ICD-10, HCPC, etc.)

An awareness of industry claim practices

Strong attention to detail

Excellent written and verbal communication skills

Capacity to work in a fast-paced environment

Exceptional customer service skills

Flexibility to handle multiple priorities while maintaining a high level of professionalism

Ability to work as part of a cohesive team

Potential for limited travel

Do you see yourself in this role even if you haven't checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.Not ready to apply yet but want to stay in touch? to stay connected until the time is right for you Life is brighter when you work at Sun Life

Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more

Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account

A flexible work environment with a friendly, caring, collaborative and inclusive culture

Great Place to Work Certified in Canada and the U.S.

Named as a "Top 10" employer by the Boston Globe's "Top Places to Work" two years running

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. If you are a California resident, the salary range for this position is:

Southern region: $57,100-$85,700 annually

Central region: $60,200-$90,300 annually

Northern region: $64,400-$96,600 annually

If you are a Colorado resident , the salary range for this position is $54,500-$81,800 annually. If you are a New York resident , the salary range for this position is $64,400-$96,600 annually. If you are Washington resident , the salary range for this position is $60,200-$90,300 annually.We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at to learn more.At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.