Billing Advocate Associate

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* Job Description:

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* 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.  
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* The opportunity:

** 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.

** 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…