Current jobs related to Claims Analyst, Health and Risk Solutions - Wellesley Hills - Sun Life

  • Insurance Claims Specialist

    3 weeks ago

    Woodland Hills, California, United States Baldwin Risk Partners Full time

    Job Summary:We are seeking a highly skilled and customer-focused Customer Service Representative to join our team at Baldwin Risk Partners. As a key member of our insurance team, you will be responsible for providing exceptional customer service to our clients, ensuring their insurance needs are met with accuracy and efficiency.Key Responsibilities:Customer...

  • Senior Informatics Analyst

    7 days ago

    Wellesley, Massachusetts, United States CVS Health Full time

    Job SummaryWe are seeking a highly skilled and motivated Senior Analyst, Informatics to join our expanding IFP risk adjustment analytics team. In this role, you will play a crucial role in supporting monthly program evaluations for IHA, chart reviews and other IFP core programs.Key ResponsibilitiesLead the reconciliation of data from various sourcesIdentify...

  • AML Risk Analyst

    4 weeks ago

    Wellesley, Massachusetts, United States Needham Bank Full time

    Position Overview: BSA Compliance AnalystThe BSA Compliance Analyst plays a crucial role in identifying and mitigating BSA-related risks, along with fulfilling other responsibilities as directed by management.Key Responsibilities:Examine BSA/AML alerts for potential issuesInvestigate and analyze suspicious transactionsPrepare and submit CTR/SAR...

  • Fraud Claims Analyst

    3 weeks ago

    Farmington Hills, Michigan, United States Kelly Services Full time

    Job OverviewAt Kelly Services, we are dedicated to matching you with a role that fits your skills and aspirations. Currently, we are looking for a Fraud Claims Analyst to contribute to a leading Financial Services organization.Why Consider This Opportunity? Competitive hourly wage of $21.00 Weekly compensationWork Schedule: Monday to Friday, 7:30 AM to 4:00...

  • Claims and Risk Management Specialist

    1 week ago

    Fairless Hills, Pennsylvania, United States Silvi Concrete Products, Inc. Full time

    Job SummarySilvi Concrete Products, Inc. is seeking an experienced Claims and Risk Management Specialist to spearhead our handling and analysis of both workers' compensation and third-party property damage and bodily injury claims.Key ResponsibilitiesDevelop and maintain comprehensive claims management processes to ensure consistent and efficient claims...

  • BSA Risk Analyst

    1 week ago

    Wellesley, Massachusetts, United States Needham Bank Full time

    Job SummaryThis role is responsible for identifying and preventing Bank Secrecy Act (BSA) risks, as well as other functions as assigned by management.Key ResponsibilitiesReview BSA/AML alerts, conduct suspicious activity investigations, and file CTR/SAR reports as needed.Monitor accounts and transactions using various reports and the Bank's AML/Fraud...

  • Medical Claims Reconciler

    3 days ago

    Beverly Hills, California, United States SF Staffing Solutions Full time

    Job SummaryAt SF Staffing Solutions, we are seeking a highly skilled Medical Claims Reconciler to join our team. As a key member of our revenue cycle team, you will play a critical role in ensuring the accuracy and efficiency of our medical claims processing.Key Responsibilities:Reconcile medical claims from patient, client, and Third Party insurance...

  • Medical Claims Reconciler

    7 days ago

    Beverly Hills, California, United States SF Staffing Solutions Full time

    Job SummaryWe are seeking a highly skilled Medical Claims Reconciler to join our team at SF Staffing Solutions.The successful candidate will be responsible for reconciling medical claims to collect revenue for our organization. This role involves working with patient, client, and/or Third Party insurance bills, and may require working on one or more of these...

  • Lead Risk Analyst for Business Unit

    3 weeks ago

    Auburn Hills, Michigan, United States DC Tek Inc. Full time

    Job OverviewPosition Title: Lead Risk Analyst for Business UnitCompany: DC Tek Inc.Location: Hybrid Work EnvironmentRole Summary:The Lead Risk Analyst for Business Unit is a pivotal role that may involve individual contributions or leadership of a small team dedicated to evaluating the operational risks associated with their respective business unit.Key...

  • ERP Business Solutions Analyst

    1 week ago

    Bloomfield Hills, Michigan, United States Stafford Gray Full time

    Job Description**Job Title:** ERP Business Solutions Analyst**Job Summary:** We are seeking an experienced ERP Business Solutions Analyst to join our team at Stafford Gray. The successful candidate will be responsible for analyzing and implementing business solutions using Oracle ERP Financials.Key Responsibilities:Assess proposed business and technical...

  • Technical Solutions Analyst

    4 weeks ago

    Temple Hills, Maryland, United States Leidos Holding Full time

    Job Title: Technical AnalystCompany: LeidosLeidos is a prominent Fortune 500 organization recognized for providing cutting-edge solutions through the contributions of its diverse and skilled workforce. The company is committed to the success of its clients and operates with a focus on sustainability. If you are seeking a rewarding career opportunity,...

  • Quantitative Risk Analyst

    4 days ago

    Rolling Hills, United States Fusion Dynamics Full time

    About UsFusion Dynamics is a leading provider of innovative solutions for the financial services industry. Our team of experts is passionate about developing cutting-edge models for risk management in banks using modern data science methods.What We OfferA comprehensive training program in Risk & Analytics, where you will gain in-depth industry knowledge and...

  • Claims Investigator

    4 months ago

    Forest Hills, United States Daniel J. Hannon and Associates, Inc. Full time

    Job DescriptionJob DescriptionCompany Info:Daniel J. Hannon & Associates, Inc. (DJH) is a Long Island-based insurance claims adjusting/investigating firm which works on behalf of insurance companies, TPAs, law firms and municipalities primarily in the NYC tri-state area, as well as throughout the United States.Job Description:DJH has an immediate need for...

  • Business Solutions Analyst

    5 days ago

    Arden Hills, Minnesota, United States Insight Global Full time

    Business Solutions AnalystInsight Global is seeking an experienced Business Solutions analyst to join a project team to expand functionality of our global medical device tracking system to meet our commercial objectives.This role will collaborate closely with cross-functional teams, understanding business needs, and leveraging their analytical and technical...

  • Complex Claims Director, General Liability

    1 month ago

    Parsippany-Troy Hills, United States AIG Full time

    Job DescriptionWho we areAmerican International Group, Inc. (AIG) is a leading global insurance organization. Building on 100 years of experience, today AIG member companies provide a wide range of property casualty insurance, life insurance, retirement solutions, and other financial services to customers in more than 80 countries and jurisdictions. These...

  • BSA Compliance Analyst

    4 weeks ago

    Wellesley, Massachusetts, United States Needham Bank Full time

    Position Overview: BSA Compliance AnalystThe BSA Compliance Analyst plays a crucial role in identifying and mitigating BSA-related risks while executing various responsibilities as directed by management.Key Responsibilities:Evaluate BSA/AML alertsInvestigate potential suspicious activitiesPrepare and submit CTR/SAR reportsConduct thorough Enhanced Due...

  • Quantitative Risk Analyst

    2 weeks ago

    Rolling Hills, United States Fusion Dynamics Full time

    About Fusion DynamicsFusion Dynamics is a leading company in the financial services industry, providing expertise, IT skills, and passion to renowned clients. We are committed to accompanying our clients in their digital transformation with a tailored range of services.What to Expect with UsIn our comprehensive training program, you will gain in-depth...

  • Business Solutions Analyst

    1 week ago

    Arden Hills, Minnesota, United States Insight Global Full time

    Job Title: Business Solutions AnalystLocation: HybridEmployment Type: 6-month ContractSalary: $50-64/hrJob Description:Business Opportunity:Insight Global is seeking an experienced Business Solutions Analyst to join a project team to expand the functionality of our global medical device tracking system to meet our commercial objectives.Key...

  • Business Solutions Analyst

    7 days ago

    Chino Hills, California, United States Rapid Legal Full time

    About the OpportunityRapid Legal is a leading provider of legal support services, and we're seeking a skilled Business Analyst to join our team. As a Business Analyst, you'll play a critical role in driving our strategic goals by identifying, improving, and developing technology solutions.Key ResponsibilitiesElicit, analyze, and specify requirements to...

  • 2025 BNY Analyst Program

    2 weeks ago

    Wellesley, United States BNY Mellon Full time

    2025 BNY Analyst Program – Growth Ventures At BNY, our culture empowers you to grow and succeed. As a leading global financial services company at the center of the world’s financial system we touch nearly 20% of the world’s investible assets. Every day around the globe, our 50,000+ employees bring the power of their perspective to the table to...

Claims Analyst, Health and Risk Solutions

4 months ago

Wellesley Hills, United States Sun Life Full time

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 (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

**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.

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