Overpayment Recovery Analyst
Sun Life Financial, Wellesley, MA, United States
Health And Risk Solutions Overpayment Recovery Analyst
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.
The opportunity: The Health and Risk Solutions Overpayment Recovery Analyst is primarily responsible for conducting reconciliations for individual stop loss claim reimbursements. Additional responsibilities include handling escheatment, offsets within claims system, as well as various special projects.
How you will contribute:
Track, calculate and pursue overpayments identified within Stop Loss department. This includes researching of files, having full understanding of claims, type of overpayment, overpayment resolution options and total knowledge of systems used by claims department
Follow up of overpayment requests which may include discussions with Administrator, Claim Analyst, Broker both internal and external customers via conversation and/or letters, ability to provide detailed descriptions of circumstances around overpayment and provide specific details from claim files, conduct discussions with internal claims analysts
Provide monthly current recovery reports (analysis, trending, actions, status), contacting external customers (Administrator/Broker/outside collection agency)
Receive escheatment report, investigate customer data and provide data to banking for potential stop pay/re-issue of checks
What you will bring with you :
Ability to work with a diverse range of people
Requires expert level understanding of the Stop Loss claims process or Medical Claims with respect to how overpayments are determined, processes for write offs, succinct, detailed communication to external customers requesting monies.
5+ years understanding of first dollar stop loss claims or medical claims, Prior experience in medical or Stop Loss claim adjudication
Proficient in Excel with advanced skills, including complex formula construction, pivot table manipulation, Vlookup, queries creation
Adept knowledge in navigating and utilizing SharePoint features at an intermediate level, including document management, tracker creation, and basic site administration
Strong understanding of business and relationship building with external customers
Highly skilled verbal and written communication skills
Do you see yourself in this role even if you haven't checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.
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!
Life is brighter when you work at Sun Life
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.
Salary Range: $68,200 - $102,300At 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.
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.
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.
The opportunity: The Health and Risk Solutions Overpayment Recovery Analyst is primarily responsible for conducting reconciliations for individual stop loss claim reimbursements. Additional responsibilities include handling escheatment, offsets within claims system, as well as various special projects.
How you will contribute:
Track, calculate and pursue overpayments identified within Stop Loss department. This includes researching of files, having full understanding of claims, type of overpayment, overpayment resolution options and total knowledge of systems used by claims department
Follow up of overpayment requests which may include discussions with Administrator, Claim Analyst, Broker both internal and external customers via conversation and/or letters, ability to provide detailed descriptions of circumstances around overpayment and provide specific details from claim files, conduct discussions with internal claims analysts
Provide monthly current recovery reports (analysis, trending, actions, status), contacting external customers (Administrator/Broker/outside collection agency)
Receive escheatment report, investigate customer data and provide data to banking for potential stop pay/re-issue of checks
What you will bring with you :
Ability to work with a diverse range of people
Requires expert level understanding of the Stop Loss claims process or Medical Claims with respect to how overpayments are determined, processes for write offs, succinct, detailed communication to external customers requesting monies.
5+ years understanding of first dollar stop loss claims or medical claims, Prior experience in medical or Stop Loss claim adjudication
Proficient in Excel with advanced skills, including complex formula construction, pivot table manipulation, Vlookup, queries creation
Adept knowledge in navigating and utilizing SharePoint features at an intermediate level, including document management, tracker creation, and basic site administration
Strong understanding of business and relationship building with external customers
Highly skilled verbal and written communication skills
Do you see yourself in this role even if you haven't checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.
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!
Life is brighter when you work at Sun Life
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.
Salary Range: $68,200 - $102,300At 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.
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.