🚀 Senior Consultant, Supplemental Health

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 health‑care navigation.

We are seeking a highly organized and detail‑oriented Senior Consultant, Supplemental Health Claims to process and adjudicate supplemental health insurance claims in a hybrid work model. The role requires accuracy and timely payment of claims while providing exceptional customer service to policyholders. You will serve as a go‑to resource for the team, ensuring the highest level of accuracy and service for clients.

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 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 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 providers.
• Respond to inquiries and provide exceptional customer service to resolve 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.
• Evaluate current processes for efficiency and effectiveness.
• Provide manager support by assisting with decision making and problem‑solving.

Qualifications

• Ability to work with a diverse range of people.
• 5+ years of experience in supplemental health insurance claims processing or medical billing.
• Strong knowledge of medical terminology, coding systems (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 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 efficiently.
• Commitment to delivering outstanding customer service and maintaining high professionalism.
• Ability to attain and maintain appropriate TPA licenses in accordance with the Claims Licensing Policy.

Salary: $71,100‑$106,700 (annual base salary, plus discretionary annual incentive based on performance).

Not ready to apply yet? Join our talent community to stay connected until the time is right for you.

Benefits

• Generous vacation and sick time.
• Market‑leading paid family, parental, and adoption leave.
• Company‑paid life and AD&D insurance.
• Disability programs and partially paid sabbatical program.
• 401(k) employer match, stock purchase options and an employer‑funded retirement account.
• Flexible, inclusive, and collaborative work environment supporting career growth.

We are committed to fostering an inclusive environment where all employees feel they belong. We encourage applications from qualified individuals from all backgrounds. We do not require lie detector tests. We will make reasonable accommodations for qualified applicants with disabilities. Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with applicable laws. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Posting End Date: 09/11/2025