Billing & Claims Advocate (Hybrid)

Sun Life; Kansas City (MO); Hybrid; USD 48,000 - 64,000; Full time

Job summary

Sun Life U.S. is a leading provider of employee and government benefits, with a hybrid work model requiring in-office presence two days per week.

The Insurance Claims Advocate supports end-to-end medical billing advocacy and claims resolution within the ICAT team. We seek candidates with health insurance, billing, and advocacy experience, strong organizational skills, and the ability to handle sensitive situations with diplomacy.

Qualifications

• Experience in health insurance, medical billing, or insurance advocacy.
• Proven expertise in medical billing audits, appeals, and coordination of benefits.
• Excellent organizational and prioritization skills; able to manage multiple member matters simultaneously.
• Computer proficiency in MS Office, Adobe or similar document management tool, Carrier/plan portal proficiency.
• Salesforce experience preferred.
• Ability to handle sensitive situations with diplomacy and tenacity.
• Team player with a strong work ethic, perseverance, and 'can do' attitude.
• Member centric focus

Responsibilities

• Investigate and resolve unpaid, underpaid, or denied claims through diligent follow-up, escalation, and appeals, ensuring accuracy in audits of medical bills, Explanation of Benefits, and payment histories.
• Track and submit out-of-network claims, identify errors, coding issues, or coverage mismatches.
• Reduce member out-of-pocket costs through correction-claims and coordination of benefits.
• Serve as a knowledgeable representative/mediator among members, providers, and insurance carriers, communicating professionally and clearly on the member's behalf.
• Document all claim activities, interactions, and recommendations thoroughly in Salesforce, aligning with departmental Standard Operating Procedures.
• Utilize Microsoft Office Suite (Excel for tracking, Word for appeals and summaries, Outlook for communications), PDF/document management tools for review and annotation, and insurance carrier portals/call systems for status checks and escalations.
• Basic medical coding familiarity (CPT/HCPCS/ICD)
• Deliver consistent, quality advocacy services across all Insurance Claims Advocacy products, acting as a resource and escalation point for complex cases
• Mentor new hires, lead onboarding and cross-training, and conduct periodic case reviews for skill development and adherence to policies.
• Assist in drafting, reviewing, and refining SOPs; support data collection and analysis for performance metrics; and collaborate on identifying and addressing process gaps or improvements.

Skills

Health insurance

Medical billing

Audits & appeals

Coordination of benefits

Salesforce

MS Office

Medical coding

Communication

Team collaboration

Tools

Salesforce

Microsoft Office

Job description

Sun Life U.S. is a leading provider of employee and government benefits, with a hybrid work model requiring in-office presence two days per week.

The Insurance Claims Advocate supports end-to-end medical billing advocacy and claims resolution within the ICAT team. We seek candidates with health insurance, billing, and advocacy experience, strong organizational skills, and the ability to handle sensitive situations with diplomacy.