The board
- Hours
- Full time
- Where
- U.S. Employees (Remote)
- Posted
- Sep 23
Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.
At Sun Life, we're driven by our Purpose: helping our Clients achieve lifetime financial security and live healthier lives.
What you'd do
- Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim
- The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions
- Maintain claim block and meet departmental production and quality metrics
- An awareness of industry claim practices
- Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records
- Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc.
- Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process
- Establish cooperative and productive relationships with professional resources
- A minimum of three to five years’ experience processing first dollar medical claims or stop loss claim processing
- Demonstrated ability to work as part of a cohesive team
- Starts
- 2026-09-23