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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in managing complex claims within the medical stop loss and health insurance sectors, emphasizing leadership, analytical problem-solving, and effective stakeholder management. Proficient in claims management systems and committed to driving operational effectiveness and customer service excellence.
Highest-signal resume keywords
Medical Stop Loss Insurance ExperienceClaims Management Systems ProficiencyLeadership SkillsAnalytical Problem-SolvingStakeholder Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims Practices KnowledgeNegotiation SkillsData AnalysisProcess Efficiency ImplementationClaims Processing
Soft Skills
Communication SkillsMentoringCollaboration
Tools & Technologies
Sun Life Products
Industry Keywords
Health Insurance ClaimsState and Federal LawsOperational EffectivenessCustomer Service Excellence
About the role
Key responsibilities & impact- Lead evaluation, investigation, negotiation, and settlement of complex claims
- Balance policyholder interests with company objectives
- Supervise, mentor, and develop the claims team
- Oversee work assignments, performance management, and professional development
- Monitor workflow and implement process efficiencies
- Ensure prompt and accurate claims processing
- Collaborate with third-party administrators, brokers, agents, policyholders, vendors, and legal counsel
- Drive operational effectiveness, business growth, and customer service excellence
Requirements
What you’ll need- 5+ years of medical stop loss insurance or health insurance claims experience required
- Previous management/leadership experience preferred
- Proven leadership skills and deep industry expertise
- Strong analytical and problem-solving abilities
- Experience in stakeholder management and customer-facing roles
- In-depth knowledge of claims practices, state and federal laws
- Excellent communication and negotiation skills
- Ability to analyze and communicate complex data and trends
- Proficiency with claims management systems and Sun Life products
- Ability to work with a diverse range of people
Benefits
Comp & perks- Generous vacation and sick time
- Paid family, parental and adoption leave
- Medical coverage
- Company-paid life and AD&D insurance
- Disability programs
- Partially paid sabbatical program
- 401(k) employer match
- Stock purchase options
- Employer-funded retirement account
- Flexible, inclusive and collaborative work environment
- Career growth support
- Reasonable accommodations for qualified individuals with disabilities or special disabled veterans