Senior Manager, Insurance and Claims Advocacy

Senior Manager, Insurance and Claims Advocacy

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.Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.The opportunity: The Senior Manager, Insurance and Claims Advocacy is a pivotal leader within the Clinical Solutions team at PinnacleCare, Sun Life U.S. Health and Risk Solutions. In this role, you will lead a comprehensive advocacy program that helps members navigate and maximize their health insurance while resolving complex medical billing and claim issues. You will set the vision, drive operational excellence, build scalable processes, and deliver measurable financial and experience outcomes-serving as the final escalation point for sensitive cases and establishing best practices across the organization.How you will contribute:Lead and develop a high-performing Insurance and Claims Advocacy team, including hiring, coaching, performance management, and workforce planning.Own program strategy, service delivery standards, and key performance indicators across insurance navigation and claims resolution.Oversee resolution of complex medical billing and insurance issues (denials and appeals, billing errors/coding discrepancies, out-of-network disputes), serving as the primary escalation point for sensitive cases.Guide proactive insurance navigation, including benefits education, coverage guidance, and pre-service support to remove barriers and improve member outcomes.Build and optimize scalable workflows, leveraging data, technology platforms, and responsible AI-enabled tools to improve quality, efficiency, and turnaround time.Ensure accurate, audit-ready documentation and adnce to SOPs, regulations, and quality standards.Partner cross-functionally (Sales, Client Service, Member Services, Analytics, and clinical teams) to implement improvements, support growth, and elevate the member experience.What you will bring with you:Ability to work with a diverse range of people7+ years of experience in medical billing/claims advocacy, complex claims resolution, appeals, coordination of benefits, and insurance plan analysis (including pre-authorizations and enrollment support).Bachelor's degree in healthcare administration, business, or related field required; advanced degree and/or relevant certification preferred.3+ years of progressive people leadership experience, ...For full information see follow application link. Sun Life Financial is an equal employment and affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status or any other characteristic protected by law. Sun Life Financial is committed to building a diverse and inclusive company culture.Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter - for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at sunlife/us to learn more.