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.

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 Insurance Claims Advocate is a vital member of the Insurance Claims Advocacy Team (ICAT) at Pinnacle Care, 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.

• 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.
• 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)

• 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.

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…