Senior Manager, Insurance and Claims Advocacy

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 6400 employees and associates in our partner dental practices and operate nationwide.

At Sun Life were driven by our 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 youll 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.

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.

The opportunity: The Senior Manager Insurance and Claims Advocacy is a pivotal leader within the Clinical Solutions team at PinnacleCare Sun Life U.S. Health and Risk this role you will lead a comprehensive advocacy program that helps members navigate and maximize their health insurance while resolving complex medical billing and claim issues. You will set the vision drive operational excellence build scalable processes and deliver measurable financial and experience outcomesserving as the final escalation point for sensitive cases and establishing best practices across the organization.

How you will contribute:

• Lead and develop a high-performing Insurance and Claims Advocacy team including hiring coaching performance management and workforce planning.
• Own program strategy service delivery standards and key performance indicators across insurance navigation and claims resolution.
• Oversee resolution of complex medical billing and insurance issues (denials and appeals billing errors/coding discrepancies out-of-network disputes) serving as the primary escalation point for sensitive cases.
• Guide proactive insurance navigation including benefits education coverage guidance and pre-service support to remove barriers and improve member outcomes.
• Build and optimize scalable workflows leveraging data technology platforms and responsible AI-enabled tools to improve quality efficiency and turnaround time.
• Ensure accurate audit-ready documentation and adherence to SOPs regulations and quality standards.
• Partner cross-functionally (Sales Client Service Member Services Analytics and clinical teams) to implement improvements support growth and elevate the member experience.

What you will bring with you:

• Ability to work with a diverse range of people
• 7 years of experience in medical billing/claims advocacy complex claims resolution appeals coordination of benefits and insurance plan analysis (including pre-authorizations and enrollment support).
• Bachelors degree in healthcare administration business or related field required; advanced degree and/or relevant certification preferred.
• 3 years of progressive people leadership experience with demonstrated success managing teams and service operations.
• Deep knowledge of payer claims adjudication CPT/ICD coding and provider billing practices; strong negotiation and escalation management skills.
• Proven ability to drive process improvement using data/analytics technology platforms (e.g. Salesforce MS Office) and responsible AI-enabled tools.
• Excellent communication skills and ability to influence cross-functional stakeholders in a fast-paced environment.

Salary:

$76200-$114300

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 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.

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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. Were proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S. weve also been recognized as a Top 10 employer by the Boston Globes 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 to 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.