Stop-Loss Claims Resolution Specialist

Stryker Corporation; Hartford (CT); On-site; Confidential; Full time

Benefits offered by this job

Comprehensive benefits

Job summary

Sun Life U.S. is seeking a Claims Resolution Consultant specializing in Stop Loss medical claims. You will serve as the expert for complex inquiries, manage end-to-end resolution, research documentation, and provide clear, professional updates to TPAs, brokers, employers, and internal teams.

Collaborate with Claims Analysts, clinical resources, and Legal to ensure accurate outcomes while upholding privacy, regulatory requirements, and Sun Life's service standards across national operations.

Qualifications

• Expert-level knowledge of Stop Loss medical claims and eligibility determination.
• Experience reviewing and supporting complex or large loss stop loss claims end-to-end.
• Strong ability to interpret plan documents and contract provisions.
• Excellent written and verbal communication with non-technical audiences.

Responsibilities

• Serve as an expert resource for Stop Loss medical claims, including complex scenarios and eligibility issues.
• Research and resolve advanced claim inquiries by analyzing claim history, medical documentation, and plan documents.
• Interpret and apply contractual language, escalating when needed for clinical, legal, or investigative review.
• Provide consultative guidance on claim status, required documentation, timelines, and next steps.
• Own inquiries from intake through closure with accountability and follow-up.

Skills

Stop Loss claims

Complex inquiries

Documentation review

Clear client communication

Cross-functional collaboration

Education

Bachelor’s degree in a relevant field

Job description

Sun Life U.S. is seeking a Claims Resolution Consultant specializing in Stop Loss medical claims. You will serve as the expert for complex inquiries, manage end-to-end resolution, research documentation, and provide clear, professional updates to TPAs, brokers, employers, and internal teams.

Collaborate with Claims Analysts, clinical resources, and Legal to ensure accurate outcomes while upholding privacy, regulatory requirements, and Sun Life's service standards across national operations.