Remote Stop Loss & Health Claims Analyst

Sun Life Financial; Baltimore (MD); Ibrido; USD 54.000 - 81.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical coverage

401(k) match

Paid time off

Career growth opportunities

Descrizione del lavoro

Sun Life Financial, a leader in employee benefits, is seeking a Stop Loss & Health Claim Analyst to review claims, interpret contracts, and determine reimbursements. This role blends analytical review with client service, ensuring documentation supports each decision while managing a block of claims within a hybrid work model.

The candidate will apply plan specifications, HIPAA and regulatory guidelines, and engage internal and external resources to optimize outcomes.

Competenze

• Minimum 3–5 years’ experience processing first dollar medical claims or stop loss claim processing.
• Demonstrated ability to work as part of a cohesive team.
• Strong written and verbal communication skills.

Mansioni

• Review claims and determine eligibility using applicable contractual provisions and plan specifications.
• Prepare written rationale for decisions based on medical records and contract terms.
• Coordinate with clinical resources and external specialists to support claims decisions.
• Maintain claim blocks and meet production and quality metrics.

Conoscenze

Claims processing

Stop Loss knowledge

Communication skills

Microsoft Office

Strumenti

Microsoft Office Suite

Descrizione del lavoro

Sun Life Financial, a leader in employee benefits, is seeking a Stop Loss & Health Claim Analyst to review claims, interpret contracts, and determine reimbursements. This role blends analytical review with client service, ensuring documentation supports each decision while managing a block of claims within a hybrid work model.

The candidate will apply plan specifications, HIPAA and regulatory guidelines, and engage internal and external resources to optimize outcomes.