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 6,400 employees and associates in our partner dental practices and operate nationwide.

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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 Solutions. In 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 outcomes—serving 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).
• Bachelor’s 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:  

$76,200-$114,300

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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