Transportation Analyst specializing in traffic and revenue forecasting for toll facilities across the United States. A hybrid role based in Portland, OR with team collaboration and data processing tasks.
About the role
- Stop Loss & Health Claim Analyst at Sun Life responsible for reviewing claims and customer service for financial risk management. Requires strong team collaboration and communication skills in healthcare context.
Responsibilities
- reviewing claims, interpreting and comparing contracts, dispersing reimbursement
- ensuring that all claims contain the required documentation to support the Stop Loss claim determination
- responsible for customer service and the financial risk associated with an assigned block of Stop Loss claims
- apply the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; claims practices, procedures and protocols
- decide on reimbursement or denial of a claim
- developing, coordinating and implementing a plan of action for each claim accepted
Requirements
- Bachelor's degree preferred
- 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
- strong written and verbal communication skills
- knowledge of Stop Loss Claims and Stop Loss industry preferred
- demonstrated success in negotiation, persuasion, and solutions-based underwriting
- ability to work in a fast-paced environment
- flexibility to handle multiple priorities while maintaining a high level of professionalism
- overall knowledge of health care industry
- proficiency using the Microsoft Office suite of products
- ability to travel
Benefits
- 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
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