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Purpose:

helping our Clients achieve lifetime financial security and live healthier lives. Our values shape how we work: caring, authentic, bold, inspiring, and impactful. When you join Sun Life, you'll work with passionate colleagues and empowering leaders who support your growth and celebrate your contributions, so you can make a meaningful difference in our Clients' lives. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

Job Description:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office.

The opportunity:

We are seeking a highly organized and detail-oriented 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.\nVerify policy information, coverage details, and any applicable endorsements or riders.\nAdjudicate claims using established guidelines and company policies.\nDetermine the accuracy of medical coding, diagnostic information, and procedure documentation.\nRequest any necessary additional information or documentation from policyholders or healthcare providers.\nCollaborate with the claims team to investigate and resolve any complex or disputed claims.\nEnsure that claims are processed and paid in compliance with industry regulations and internal procedures.\nUpdate claim status and maintain detailed and accurate records of all claim activities.\nCommunicate claim decisions, payment details, and any additional requirements to policyholders and healthcare providers.\nRespond to inquiries and provide exceptional customer service to resolve any claim-related issues or concerns.\nStay updated on industry trends, regulatory changes, and best practices in supplemental health insurance claims processing.\nPerform quality assurance reviews and mentor other Claims Consultants by providing feedback and identifying development opportunities with staff and management.\nEvaluate current processes for efficiency and effectiveness\nProvide manager support by assisting with decision making and problem-solving What you will bring with you: Ability to work with a diverse range of people.\n5+ years of experience in supplemental health insurance claims processing or medical billing.\nStrong knowledge of medical terminology, coding systems (e.g., ICD-10, CPT), and claim adjudication processes.\nFamiliarity with healthcare industry regulations, including HIPAA and state insurance laws.\nExcellent analytical skills and attention to detail to accurately review and evaluate claim information.\nProficient in using claims management software and other computer applications.\nExceptional organizational and time management skills to prioritize workload and meet deadlines.\nExcellent written and verbal communication skills to effectively interact with policyholders, providers, and internal stakeholders.\nAbility to work independently and as part of a team, demonstrating flexibility and adaptability in a fast-paced environment.\nStrong problem-solving skills, with the ability to resolve claim-related issues effectively and efficiently.\nCommitment to delivering outstanding customer service and maintaining high levels of professionalism.\nAbility to attain and maintain appropriate TPA licenses in accordance with the

Claims Licensing Policy Salary:

$71,100-$106,700 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. 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! We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a \"Top 10\" employer by the Boston Globe's \"Top Places to Work\" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities. We will make reasonable accommodations to the known physical or mental limitations 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 thebrightside@sunlife.comto request an accommodation. For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require or administer lie detector tests as a condition of employment or continued employment. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances. 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.

Job Category:

Claims -

Life & Disability Posting End Date:

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Find & Apply For Insurance Claims / Policy Clerk Jobs in Wellesley, Massachusetts

Senior Consultant, Supplemental Health