Billing Advocate Associate

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.

At Sun Life, we're 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, 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:

Location: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week.

The opportunity:

The Insurance Claims Advocate is a vital member of the Insurance Claims Advocacy Team (ICAT) at PinnacleCare, Sun Life U.S. Health and Risk Solutions. This non-exempt, non-management position delivers expert medical billing advocacy and insurance claims resolution. The Advocate provides high-touch, end-to-end member support through all Insurance Claims Advocacy products. They also act as a subject matter expert and contribute to operational excellence.

How you will contribute:

Medical Billing Advocacy & Claims Management

• Investigate and resolve unpaid, underpaid, or denied claims through diligent follow-up, escalation, and appeals, ensuring accuracy in audits of medical bills, Explanation of Benefits, and payment histories.

• Track and submit out-of-network claims, identify errors, coding issues, or coverage mismatches.
• and Reduce member out-of-pocket costs through correction-claims and coordination of benefits.
• Serve as a knowledgeable representative/mediator among members, providers, and insurance carriers, communicating professionally and clearly on the member’s behalf.
• Document all claim activities, interactions, and recommendations thoroughly in Salesforce, aligning with departmental Standard Operating Procedures.
• Utilize Microsoft Office Suite (Excel for tracking, Word for appeals and summaries, Outlook for communications), PDF/document management tools for review and annotation, and insurance carrier portals/call systems for status checks and escalations.
• Basic medical coding familiarity (CPT/HCPCS/ICD)

Cross-Product Service Delivery & Team Leadership

• Deliver consistent, quality advocacy services across all Insurance Claims Advocacy products, acting as a resource and escalation point for complex cases
• Mentor new hires, lead onboarding and cross-training, and conduct periodic case reviews for skill development and adherence to policies.
• Assist in drafting, reviewing, and refining SOPs; support data collection and analysis for performance metrics; and collaborate on identifying and addressing process gaps or improvements.

Professional Skills & Attributes

• Demonstrate strong verbal, written, and interpersonal communication; clear explanation of complex billing and insurance issues; and confident engagement with all stakeholders.
• Employ critical thinking, analytical ability, and attention to detail to resolve problems and build defensible, accurate comparisons.
• Display excellent organizational skills, managing multiple cases simultaneously with a sense of ownership, accountability, and timeliness.
• Handle sensitive situations with diplomacy, demonstrate persistence in follow-through, and maintain a collaborative, client-focused attitude.
• Adept at de-escalating and addressing client concerns while problem solving for suitable solutions for the client

What you will bring with you:

• Experience in health insurance, medical billing, or insurance advocacy.
• Proven expertise in medical billing audits, appeals, and coordination of benefits.Exceptional verbal, written, and interpersonal communication skills.
• Excellent organizational and prioritization skills; able to manage multiple member matters simultaneously.
• Computer proficiency in MS Office, Adobe or similar document management tool, Carrier/plan portal proficiency
• Salesforce experience preferred.
• Ability to handle sensitive situations with diplomacy and tenacity.
• Team player with a strong work ethic, perseverance, and ‘can do’ attitude.
• Member centric focus

Salary: $47,600 - 64,300

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.

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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. 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 accommodationsto the known physical or mental limitationsof 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 [email protected] 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.

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