Senior Health Claims Lead & Mentor

Sunlife; Wellesley (MA); Hybrid; USD 71,000 - 106,000; Full time

Job summary

Sun Life U.S. is seeking a Senior Claim Analyst to lead the evaluation, investigation, negotiation, and settlement of complex medical and stop loss claims. You will manage risk, coordinate activities across multiple parties, and mentor junior analysts to ensure accurate reimbursements and compliance.

You will work in a collaborative, hybrid environment, supporting policyowners, administrators, and brokers while staying ahead of industry trends and regulatory changes.

Qualifications

• 7+ years of experience handling complex medical claims including stop loss and health reinsurance.
• Deep knowledge of complex claim practices, legal precedents, and healthcare legislation.
• Strong judgment, initiative, and consultative decision-making.

Responsibilities

• Manage overall claim risk and pay/deny decisions for complex Stop Loss claims.
• Coordinate complex claim activity across multiple parties and ensure on-time completion.
• Identify trends in medical and prescription data and apply responsive case management strategies.
• Develop and refine claims policies and best practices with peers and leadership.
• Coach and mentor team members and train new hires.
• Lead field visits and settlement discussions.

Skills

Complex medical claims

Stop Loss knowledge

Negotiation skills

Communication skills

Leadership

Policyholder liaison

Mentoring

Job description

Sun Life U.S. is seeking a Senior Claim Analyst to lead the evaluation, investigation, negotiation, and settlement of complex medical and stop loss claims. You will manage risk, coordinate activities across multiple parties, and mentor junior analysts to ensure accurate reimbursements and compliance.

You will work in a collaborative, hybrid environment, supporting policyowners, administrators, and brokers while staying ahead of industry trends and regulatory changes.