Remote Stop-Loss Claims Analyst

Sun Life Financial; Baltimore, Northern (MD, KY); Hybrid; USD 54,000 - 81,000; Full time

Benefits offered by this job

Medical coverage

Vacation and sick time

Paid family leave

401(k) employer match

Stock purchase options

Employer-funded retirement account

Job summary

Sun Life Financial is seeking a Stop Loss & Health Claim Analyst in a hybrid US role. You will review medical stop loss claims, interpret contracts, and determine eligibility and reimbursement decisions based on plan documents and regulations.

You will coordinate with clinical resources, prepare rationales for denials or approvals, and maintain accurate claim blocks while meeting performance metrics.

Qualifications

• A minimum of three to five years’ experience processing first dollar medical claims or stop loss claim processing.
• Strong written and verbal communication skills.
• Knowledge of HIPAA/privacy and healthcare regulations.

Responsibilities

• Determine eligibility of assigned claims by applying contractual provisions and plan specs.
• Prepare written rationale for claim decisions based on medical records and contracts.
• Maintain claim block and meet production and quality metrics.
• Coordinate with internal/external resources to add value to the process.

Skills

Stop Loss Claims

Claims processing

Microsoft Office

Tools

Microsoft Office

Job description

Sun Life Financial is seeking a Stop Loss & Health Claim Analyst in a hybrid US role. You will review medical stop loss claims, interpret contracts, and determine eligibility and reimbursement decisions based on plan documents and regulations.

You will coordinate with clinical resources, prepare rationales for denials or approvals, and maintain accurate claim blocks while meeting performance metrics.