Senior Health & Risk Claims Leader

Sun Life; Milwaukee (WI); Hybrid; USD 68,000 - 102,000; Full time

Benefits offered by this job

Generous vacation and sick time

Paid family, parental and adoption-lea

Medical coverage

Life and AD&D insurance

Disability programs

Sabbatical program

401(k) match

Stock purchase options

Job summary

Sun Life U.S. is seeking a Health and Risk Solutions Senior Claim Analyst to lead the evaluation, negotiation and settlement of complex medical claims. The role balances accurate payments with policy-owner interests and involves coordinating across internal and external partners.

You will mentor analysts, support training, and contribute to evolving claims policies while maintaining strong relationships with brokers, administrators and vendors in a collaborative, growth-oriented environment.

Qualifications

• 7+ years of experience handling complex claims (Medical Stop Loss or complex medical claims).
• Deep knowledge of claim practices, legal precedents and healthcare legislation.
• Excellent communication, negotiation and influencing skills.

Responsibilities

• Manage overall claim risk and pay/deny decisions for complex Stop Loss claims.
• Coordinate complex claims activity across multiple parties to keep actions on schedule.
• Identify evolving medical and prescription drug trends and apply responsive case management.
• Coach and mentor teammates and help train new hires on reimbursement practices.
• Develop and refine claims policies and best practices with leadership.

Skills

Complex claims handling

Medical Stop Loss

Communication & negotiation

Leadership & mentoring

Job description

Sun Life U.S. is seeking a Health and Risk Solutions Senior Claim Analyst to lead the evaluation, negotiation and settlement of complex medical claims. The role balances accurate payments with policy-owner interests and involves coordinating across internal and external partners.

You will mentor analysts, support training, and contribute to evolving claims policies while maintaining strong relationships with brokers, administrators and vendors in a collaborative, growth-oriented environment.