Senior Consultant, Supplemental Health

Portland, OR, United States

Senior Consultant, Supplemental Health page is loaded Senior Consultant, Supplemental Health Apply locations Portland, ME U.S. Employees (Remote) U.S. Telecommuters time type Full time posted on Posted 2 Days Ago job requisition id JR00094601 You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

Job Description:

Location: We support US flexible working arrangements in the contiguous 48 states.

At Sun Life, we look for optimistic people who want to make life brighter for ourClients.We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work.Every day,you’ll be empowered and challengedbyworking withdynamic colleaguesto find new and innovative ways to make Sun Life the best benefits company in America.

The opportunity:

We are seeking a highly organized and detail-oriented individual to join our team as Senior Consultant, Supplemental Health Claims. In this role you will be responsible for processing and adjudicating supplemental health insurance claims in accordance with company policies and regulatory guidelines. Your primary objective will be to ensure accurate and timely claim payments, while providing exceptional customer service to policyholders. In addition, you will serve as a leader and go to resource for the team to ensure accuracy and the highest level of service for Clients.

How you will contribute:

Review and evaluate supplemental health insurance claims for eligibility, completeness, and accuracy.

Verify policy information, coverage details, and any applicable endorsements or riders.

Adjudicate claims using established guidelines and company policies.

Determine the accuracy of medical coding, diagnostic information, and procedure documentation.

Request any necessary additional information or documentation from policyholders or healthcare providers.

Collaborate with the claims team to investigate and resolve any complex or disputed claims.

Ensure that claims are processed and paid in compliance with industry regulations and internal procedures.

Update claim status and maintain detailed and accurate records of all claim activities.

Communicate claim decisions, payment details, and any additional requirements to policyholders and healthcare providers.

Respond to inquiries and provide exceptional customer service to resolve any claim-related issues or concerns.

Stay updated on industry trends, regulatory changes, and best practices in supplemental health insurance claims processing.

Perform quality assurance reviews and mentor other Claims Consultants by providing feedback and identifying development opportunities with staff and management.

What you will bring with you:

High school diploma or equivalent work experience.

Minimum of 5 years of experience in supplemental health insurance claims processing or medical billing.

Strong knowledge of medical terminology, coding systems (e.g., ICD-10, CPT), and claim adjudication processes.

Familiarity with healthcare industry regulations, including HIPAA and state insurance laws.

Excellent analytical skills and attention to detail to accurately review and evaluate claim information.

Proficient in using claims management software and other computer applications.

Exceptional organizational and time management skills to prioritize workload and meet deadlines.

Excellent written and verbal communication skills to effectively interact with policyholders, providers, and internal stakeholders.

Ability to work independently and as part of a team, demonstrating flexibility and adaptability in a fast-paced environment.

Strong problem-solving skills, with the ability to resolve claim-related issues effectively and efficiently.

Commitment to delivering outstanding customer service and maintaining high levels of professionalism.

Ability to attain and maintain appropriate TPA licenses in accordance with the Claims Licensing Policy

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!

Life is brighter when you work at Sun Life

Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical, and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more

Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account

A flexible work environment with a friendly, caring, collaborative and inclusive culture

Great Place to Work Certified in Canada and the U.S.

Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

If you are a California resident, the salary range for this position is:

Southern region: $75,800 – 113,700 annually

Central region: $79,900 – 119,900 annually

Northern region: $85,400 – 128,100 annually

If you are a Colorado resident, the salary range for this position is $72,300 – 108,500 annually.

If you are a New York resident, the salary range for this position is $85,400 – 128,100 annually.

If you are Washington resident, the salary range for this position is $79,900 – 119,900 annually.

The full range minimum and maximum listed in the job posting is tied to the GCF level and job family.

We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.

Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

#LI-remote

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email [email protected] to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

Job Category:

Claims - Life & Disability Posting End Date:

19/05/2024 All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Shine together

At Sun Life, you can be your most brilliant self. Our supportive, flexible, and inclusive work environment is one where you – and your career – can thrive. Whatever your aspirations, collaborative leaders and colleagues are ready to help you learn, grow, and succeed.

We’re a global company with a passion for people. Our purpose is to help Clients achieve lifetime financial security and live healthier lives. As a team of 30,000 across 26 countries, our impact is far-reaching, and locally relevant There’s power in numbers. As part of Sun Life’s growing team, you have an impact on people in your community and around the world.

Shape the future

With an optimistic eye on a brighter future, we drive to innovate. Be part of leading change, push boundaries and try new ways of working. Use data to drive bold actions. Be agile and pivot as we test and learn. At Sun Life, we’re driving transformation, sustainability and innovation for our Clients, employees, partners, and communities. Join us. Together, we can make the future brighter.

#J-18808-Ljbffr