Hybrid Senior Consultant, Supplemental Health

at Sun Life

• Job title: Senior Consultant, Supplemental Health
• Job type: Full Time
• Experience level: Senior
• Salary: $71,100 - $106,700 per year
• Degree requirement: No Education Requirement
• Location requirements: Hybrid, Portland, United States

About the role

• Senior Consultant processing and adjudicating supplemental health insurance claims at Sun Life. Ensuring accurate claims payments and providing exceptional customer service to policyholders.

Responsibilities

• 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
• Evaluate current processes for efficiency and effectiveness
• Provide manager support by assisting with decision making and problem-solving

Requirements

• 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

Benefits

• Health insurance
• Generous vacation and sick time
• Market-leading paid family, parental and adoption leave
• Medical coverage
• Company paid life and AD&D insurance
• Disability programs
• Partially paid sabbatical program
• 401(k) employer match
• Stock purchase options
• Employer-funded retirement account
• Flexible, inclusive and collaborative work environment that supports career growth