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

Sun Life

Verified Company

Portland, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

You are as unique as your background, experience and point of view. Here, you'll be encouraged, empowered and challenged to be your best self.

You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you.

Your leaders will inspire and help you reach your potential and soar to new heights.

Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do.

Discover how you can make a difference in the lives of individuals, families and communities around the world.

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.

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:

Determine on a timely basis, the eligibility of assigned claims
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 (ICD10, HCPC, etc.)
An awareness of industry claim practices
Strong attention to detail
Excellent written and verbal communication skills
Capacity to work in a fastpaced 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

Life is brighter when you work at Sun Life

Excellent benefits and wellness programs to support the three pillars of your wellbeing mental, physical and financial including generous vacation and sick time, marketleading paid family, parental and adoption leave, a partiallypaid 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 employerpaid match as well as an employerfunded 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.

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.

LI-remote

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 a