Operations Analyst

Sun Life•Baltimore, MD

25d•$49,200 - $66,400•Hybrid

About The Position

Sun Life U.S. is a leading provider of employee and government benefits, serving approximately 50 million Americans. We offer a comprehensive portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. With over 6,400 employees and associates across our partner dental practices, we operate nationwide. Sun Life embraces a hybrid work model, balancing in-office collaboration with the flexibility of virtual work, requiring team members and leaders to be present in the office at least 2 days per week.

Requirements

Bachelor’s degree or equivalent work experience
2-3 years of experience in the financial services industry
Strong PC Proficiency
Ability to successfully meet deadlines and achieve goals

Nice To Haves

2 years of experience working in Stop Loss claims and/or Stop Loss underwriting
Ability to comprehend and interpret client plan documents as well as Stop Loss policies
Broad knowledge of Stop Loss Insurance products and processes
Ability to think creatively to resolve complex or non-routine issues
Strong written and verbal communication skills and experience
Ability to effectively coach, develop and motivate team members to achieve Department and SLF goals
Strong negotiation, drawing conclusions and problem-solving skills and experience
Ability to develop and maintain effective, professional business relationships across all levels of the organization and external TPA administrators and customers
Knowledge of company computer systems and products a strong plus

Responsibilities

Ensuring new and renewal contracts match underwriting approvals and TPA Work Arounds (Specific, Aggregate and Health Navigator dates, claim basis, rates, # of lives, Certain Fees, Address, Monthly Accommodation, Terminal Liability, Lasers, Retirees, Transplant Vendor Endorsement, and Brokers, GA, TPA correctness).
Customizing contracts according to TPA Work Arounds and sales, including sub-account customization for multiple accounts with different claim basis, rates, and names.
Setting up the claims system (CMS) with accurate information such as Deductibles, claim basis, Certain Fees, Lasers, Retirees (covered or not), and entering all contacts for policy, Payee, and Banking information.
Setting up Compass for billing.
Verifying claim system (CMS) information accuracy (Deductibles, claim basis, Certain Fees, Lasers, Retirees), ensuring correct Payee and Banking information, and updating contacts.
Reviewing previous year's contracts for rate tier changes and updating Compass if rate tiers change or Health Navigator is added.
Administering contract revisions as notified by underwriting.
Performing other duties as assigned.