Senior Consultant Supplemental Health

Senior Consultant, Supplemental Health Claims

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.

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. 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...

Sun Life Financial is an equal employment and affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status or any other characteristic protected by law. Sun Life Financial is committed to building a diverse and inclusive company culture.