Claims Analyst, Health and Risk Solutions

4 days 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

  • Claims Analyst, Health and Risk Solutions

    2 weeks 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...

  • Overpayment Recovery Analyst

    3 weeks 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...

  • Associate Analyst, Claims

    1 month ago

    North Richland Hills, United States XPO Full time

    Job Description:What you'll need to succeed as an Associate Analyst, Claims at XPOMinimum qualifications:Bachelor's degree or equivalent related work or military experienceExceptional customer service skillsAble to communicate with management regarding the claim decision-making process Excellent written and verbal communication skillsPreferred...

  • Associate Analyst, Claims

    4 weeks ago

    North Richland Hills, United States XPO Full time

    Job Description:What you'll need to succeed as an Associate Analyst, Claims at XPOMinimum qualifications:Bachelor's degree or equivalent related work or military experienceExceptional customer service skillsAble to communicate with management regarding the claim decision-making process Excellent written and verbal communication skillsPreferred...

  • Vision Claims

    3 weeks ago

    Wellesley Hills, United States DentaQuest 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...

  • Stop Loss Clinical Consultant

    4 weeks ago

    Beverly Hills, California, United States Strategic Risk Solutions Full time

    Strategic Risk Solutions Inc. (SRS), the world's largest independent insurance company manager, is growing and looking for a highly motived Stop Loss Clinical Consultant with a current RN License to join Alpha Isle Services – our division that administers medical stop loss claims.This remote position will utilize nursing knowledge and analytical skills to...

  • Stop Loss Clinical Consultant

    1 month ago

    Beverly Hills, California, United States Strategic Risk Solutions Full time

    Strategic Risk Solutions Inc. (SRS), the world's largest independent insurance company manager, is growing and looking for a highly motived Stop Loss Clinical Consultant with a current RN License to join Alpha Isle Services – our division that administers medical stop loss claims.This remote position will utilize nursing knowledge and analytical skills to...

  • Claim Processing Representative, Dentaquest

    2 weeks ago

    Wellesley Hills, United States DentaQuest 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...

  • Analyst, Claims

    4 days ago

    North Richland Hills, United States XPO Logistics Full time

    Understand and qualify the type of claims filed; investigate and analyze cargo claims for loss, damage and delays to determine company liability and costs for damage or loss while protecting company and customer interests Understand and interpret leg Claims, Analyst, Insurance

  • Public Entities Claims Examiner Iii

    6 days ago

    Chino Hills, United States TRISTAR RISK MANAGEMENT Full time

    ***:Responsible for the prompt review of claims to determine coverage for loss/damage/injury. Conduct an efficient claim examination and investigation leading to the final resolution of liability claims, including matters in litigation. Frequent contact and interaction with involved parties including claimants and their legal representatives will be required...

  • Solution Analyst

    4 weeks ago

    Farmington Hills, United States LSPediA LLC Full time

    About LSPedia Welcome to LSPedia, a global software (SaaS) leader at the forefront of traceability, compliance, and supply chain solutions, dedicated to empowering the pharmaceutical, healthcare, and food industries. As a distinguished Top 50 Michigan Company and recognized on INC's list of the fastest-growing companies in America, LSPedia stands as a...

  • Director, Advanced Analytics Transformation

    2 weeks 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...

  • Risk Pool Auditor

    2 weeks ago

    Woodland Hills, United States MedPOINT Management Full time

    **Summary**: Responsible for reviewing claims paid in Shared and Dual Risk Pools, monitor and maintain the files audited, submitted for disputes and responses from outside entities. Responsible for the accuracy and integrity of the Hospital claims paid by MPM. Ensures interpretation and compliance with the appropriate Division of Financial Responsibility...

  • Associate Client Configuration Analyst, Dentaquest

    3 weeks ago

    Wellesley Hills, United States DentaQuest 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...

  • Enterprise Risk Information Analyst

    2 weeks ago

    Farmington Hills, United States Softworld Inc Full time

    Job Title: Enterprise Risk Information Analyst Job Location: Farmington Hills, MI 48331 Onsite Requirements: 2-5 Years Experience in SharePoint Development 3+ Years Experience in Power Platform 2+ Years Experience with Business Analysis Job Description: This role within Enterprise Risk Transformation is a role that combines the technical skillset of...

  • Enterprise Risk Information Analyst

    1 week ago

    Farmington Hills, United States Softworld, a Kelly Company Full time

    Job Title: Enterprise Risk Information Analyst Job Location: Farmington Hills, MI 48331 Onsite Requirements: 2-5 Years Experience in SharePoint Development 3+ Years Experience in Power Platform 2+ Years Experience with Business Analysis Job Description: This role within Enterprise Risk Transformation is a role that combines the technical skillset of...

  • Enterprise Risk Information Analyst

    2 weeks ago

    Farmington Hills, United States Softworld, a Kelly Company Full time

    Job Title: Enterprise Risk Information AnalystJob Location: Farmington Hills, MI 48331Onsite Requirements:2-5 Years Experience in SharePoint Development3+ Years Experience in Power Platform2+ Years Experience with Business AnalysisJob Description: This role within Enterprise Risk Transformation is a role that combines the technical skillset of SharePoint and...

  • Enterprise Risk Information Analyst

    2 weeks ago

    Farmington Hills, United States Softworld, a Kelly Company Full time

    Job Title: Enterprise Risk Information AnalystJob Location: Farmington Hills, MI 48331Onsite Requirements:2-5 Years Experience in SharePoint Development3+ Years Experience in Power Platform2+ Years Experience with Business AnalysisJob Description: This role within Enterprise Risk Transformation is a role that combines the technical skillset of SharePoint and...

  • Risk Governance Reporting Analyst

    17 hours ago

    Farmington Hills, United States w3r Consulting Full time

    Hybrid contract to hire opportunity for candidate with the ability to investigate and report on third party risk. Risk Governance Reporting Analyst Seeking a professional to perform operational risk and third-party risk management reporting and analysis to improve effectiveness and efficiency. This Analyst will assume responsibility for creating reports for...

  • Risk Governance Reporting Analyst

    17 hours ago

    Farmington Hills, United States W3R Consulting Full time

    Hybrid contract to hire opportunity for candidate with the ability to investigate and report on third party risk.Risk Governance Reporting AnalystSeeking a professional to perform operational risk and third-party risk management reporting and analysis to improve effectiveness and efficiency. This Analyst will assume responsibility for creating reports for...