Sr. Claims Analyst, Health and Risk Solutions
2 weeks ago
Join Sun Life U.S. as a Senior Claims Analyst in our Health and Risk Solutions team. Sun Life is one of Americas largest providers of employee and government benefits, serving over 50 million people with services ranging from dental and vision to medical stop?loss insurance.
Job DescriptionSun Life embraces a hybrid work model that balances in?office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office.
The OpportunityAs a Senior Claims Analyst, you will hold the highest technical expertise for a claims unit, directing the evaluation, investigation, negotiations, and settlement of complex claims and ensuring that valid claims and benefits are paid in a timely, balanced manner. You will manage relationships internally and externally, mentor agency analysts and overpayment specialists, and drive policy development.
Key Responsibilities- Manage overall claim risk, making decisions to pay or deny claims and developing comprehensive action plans for complex stop?loss claims.
- Coordinate timing and sequencing of complex claims that involve multiple parties.
- Track evolving medical and prescription trends, developing responsive case?management techniques.
- Apply deep knowledge of complex claim practices and legal precedents to resolve unique circumstances.
- Collaborate with peers and department leadership to establish and institutionalize policies.
- Communicate with policyholders, brokers, sales reps, vendors, and internal partners.
- Coach and mentor junior analysts, developing learning modules and providing training to new hires.
- Handle monthly accommodation advance payments for claims.
- Stay current with industry practices and contribute to evolving claims?management techniques.
- Act as a department leader and expert, influencing operational decisions.
- Manage assigned claim blocks efficiently, maintaining client turnaround without sacrificing service quality.
- Participate in field visits and settlement discussions.
- Seven or more years of experience handling complex claims, preferably in stop?loss.
- In?depth understanding of complex claim practices and legal precedents.
- Strong judgment and initiative, with the ability to influence company operations.
- Comprehensive knowledge of state and federal healthcare legislation as it applies to claims.
- Subject?matter expert with industry recognition and a professional network.
- Effective communicator who negotiates conflict and drives results.
- Ability to produce clear, professional written correspondence.
- Consultative mindset and creative problem?solving skills.
Salary
$68,200 $102,300 (base) plus discretionary annual incentive award.
Benefits & CultureSun Life offers a comprehensive benefits program, including generous vacation and sick time, paid family and parental leave, medical coverage, company?paid life insurance, disability programs, a partially paid sabbatical, 401(k) with employer match, stock options, and an inclusive work environment that supports career growth.
EEO StatementAll 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.
Job CategoryClaims Health & Dental
Posting End Date16/11/2025
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