Medical Billing Advocate & Claims Specialist

Sun Life; Portland (ME); Hybrid; USD 48,000 - 64,000; Full time

Job summary

Sun Life U.S. is seeking an Insurance Claims Advocate to join the Insurance Claims Advocacy Team (ICAT). This non-exempt, non-management role delivers expert medical billing advocacy and end-to-end claims resolution for members.

You will support unpaid or denied claims, document activities in Salesforce, and coordinate with providers and carriers. A background in health insurance and strong communication skills are required, with a focus on client service and operational excellence.

Qualifications

• Experience in health insurance, medical billing, or insurance advocacy.
• Expertise in medical billing audits, appeals, and coordination of benefits.
• Excellent organizational and prioritization skills.
• Proficient with MS Office, Adobe or similar document tools.
• Salesforce experience preferred.
• Able to handle sensitive situations with diplomacy.
• Team player with a strong work ethic.

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)

Skills

Health insurance

Medical billing

Insurance advocacy

Communication

Organization

Problem solving

Team player

Tools

Salesforce

MS Office

Carrier portals

Job description

Sun Life U.S. is seeking an Insurance Claims Advocate to join the Insurance Claims Advocacy Team (ICAT). This non-exempt, non-management role delivers expert medical billing advocacy and end-to-end claims resolution for members.

You will support unpaid or denied claims, document activities in Salesforce, and coordinate with providers and carriers. A background in health insurance and strong communication skills are required, with a focus on client service and operational excellence.