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.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

Job Description:

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America. 

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office.

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.

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Life is brighter when you work at Sun Life

• Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account
• A flexible work environment with a friendly, caring, collaborative and inclusive culture
• Great Place to Work® Certif