Hybrid Senior Health Claims Strategist

Sunlife; Wellesley (MA); Hybrid; USD 68,000 - 102,000; Full time

Benefits offered by this job

Generous vacation & sick time

401(k) employer match

Stock purchase options

Employer-funded retirement account

Life & AD&D insurance

Job summary

Sun Life U.S. is seeking a Senior Claim Analyst for Health & Risk Solutions to lead evaluation, investigation, negotiation, and settlement of complex claims. You will manage claim risk, mentor staff, and support training, while fostering relationships with policyholders and brokers.

The role requires deep knowledge of complex claims and applicable healthcare regulations, with a hybrid work model in the contiguous states and AK. Sun Life offers strong benefits and career growth opportunities.

Qualifications

• 7+ years of experience handling complex medical/specialty claims.
• Deep knowledge of complex claim practices, legal precedents, and claims accounting.
• Strong judgment and consultative decision-making to impact company operations.
• Industry involvement through peer presentations or professional forums.

Responsibilities

• Manage overall claim risk and pay/deny decisions using contract language.
• Coordinate complex claims activity across multiple parties and ensure timely actions.
• Coach and mentor junior team members and train new hires on reimbursement practices.
• Manage monthly accommodation advance payments and assigned claim blocks with quality service.

Skills

Complex claims handling

Stop Loss knowledge

Negotiation

Leadership

Communication

Job description

Sun Life U.S. is seeking a Senior Claim Analyst for Health & Risk Solutions to lead evaluation, investigation, negotiation, and settlement of complex claims. You will manage claim risk, mentor staff, and support training, while fostering relationships with policyholders and brokers.

The role requires deep knowledge of complex claims and applicable healthcare regulations, with a hybrid work model in the contiguous states and AK. Sun Life offers strong benefits and career growth opportunities.