Senior Health Claims & Risk Strategist

Sunlife; Memphis (TN); Hybrid; USD 71,000 - 106,000; Full time

Benefits offered by this job

Hybrid work model

Comprehensive benefits package

Paid family and parental leave

Retirement and stock options

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.

This role balances timely, accurate payments with policyholder and company interests, while mentoring colleagues and supporting new hires. The Senior Claim Analyst will coordinate cross-functional activities, stay current on industry practices, and help shape claims policies and best practices in a hybrid work environment across the contiguous

Qualifications

• 7+ years handling complex medical claims, including Stop Loss.
• Deep knowledge of complex claim practices and healthcare legislation.
• Strong judgment, initiative and consultative decision-making.
• Excellent communication, negotiation and influencing skills.
• Established industry network and SME in claims management.
• Ability to draft clear, compliant written correspondence.
• Creative, resourceful problem solving for complex matters.

Responsibilities

• Manage overall claim risk and pay/deny decisions.
• Coordinate complex claims activity across multiple parties.
• Identify and monitor medical and prescription drug trends.
• Apply knowledge of complex claim practices and precedents to resolve matters.
• Partner with leadership to refine claims policies and best practices.
• Manage communications with policyholders, brokers, sales reps, vendors, and internal partners.
• Coach and mentor less experienced team members; develop learning modules.
• Train new hires on accurate claim reimbursement and client service expectations.
• Manage monthly accommodation advance payment claims and blocks.
• Stay current on industry practices and evolving claims management techniques.
• Serve as departmental leader and subject matter expert in field visits and settlements.

Skills

Complex medical claims handling

Communication and negotiation

Leadership and mentoring

Stakeholder management

Analytical reasoning

Industry networking/SME

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.

This role balances timely, accurate payments with policyholder and company interests, while mentoring colleagues and supporting new hires. The Senior Claim Analyst will coordinate cross-functional activities, stay current on industry practices, and help shape claims policies and best practices in a hybrid work environment across the contiguous