Sun LifeHiring

Stop Loss & Health Claim Analyst

  • Remote, United States
  • Mid-level
  • Posted 13 days ago
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In one line

Claims analyst role reviewing stop loss and medical claims, applying contract terms and deciding on reimbursement; hybrid work in the US.

About the role

Each analyst owns a block of stop loss claims, weighing plan documents and medical records against policy language and coordinating clinical and legal resources where they add value. Decisions must hold up to audit and meet production and quality targets.

At a glance

Pay
Not stated in the posting
Remote scope
Remote, United States
Seniority
Mid-level
Skills
Stop Loss Claims
Posted
22 Oct 2026
Last checked
3 Nov 2026

What you will do

  • Decide eligibility for assigned claims by applying contract provisions to the medical facts
  • Keep a claim block moving while meeting departmental production and quality metrics
  • Write rationales for decisions based on plan specifications and review of medical records
  • Apply privacy and healthcare regulations such as HIPAA and the Affordable Care Act
  • Bring in medical, investigative and legal resources at the right points

What they look for

  • Three to five years processing first dollar medical claims or stop loss claims
  • Ability to work as part of a close team
  • Strong written and verbal communication

Nice to have

  • Knowledge of stop loss claims and the stop loss industry

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Claude

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Connector URL
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Muse

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Message for Muse
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Muse is available in the US only for now.

Prompt
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Questions about this job

Is this job fully remote, and from where?

Yes, it is listed as remote, aimed at candidates in the United States.

What does this job pay?

The posting does not state a salary, so there is no figure to quote.

What experience is needed?

It is a mid-level role. The posting asks for: three to five years processing first dollar medical claims or stop loss claims; ability to work as part of a close team; strong written and verbal communication. Skills it names include Stop Loss Claims.

How do I apply with Keywordise AI?

Click Apply with Keywordise AI, create an account and upload your CV. Your CV and cover letter are written for this job from what you have really done, then Keywordise applies for you. Trial: 7 days, no card.

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