Sun Life · 1 month ago
Appeals Specialist
Kansas City, Missouri
Full-time
Onsite
Entry Level
$38K/yr - $52K/yr
1+ years expSun 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. The Appeal Specialist is responsible for the investigation and resolution of all administrative and clinical appeals based upon specific regulatory and client requirements, ensuring compliance with mandated turnaround times and workflows.
FinanceFinancial ServicesInsurance
Responsibilities
Investigate, document and resolve member and provider appeals and inquiries related to appeals in accordance with State and/or Plan guidelines. Ensure all components of the appeal or request for information are researched and addressed
Assemble necessary information for the client so they may appropriately investigate an appeal when DentaQuest is secondary. If contracted to do so, also investigate the appeal and provide recommended outcome and appropriate correspondence
Monitor shared mailboxes and department e-mails to ensure cases are properly entered into department tracking system, and that requests are acknowledged and resolved timely and accurately
Manage workflow to meet department, Plan, State, and company goals and deadlines
Comply with and complete any client directives or overturns
Collaborate and partner with Complaint & Grievance team to resolve common issues oor trends
Take the lead in working with other internal departments/management team to ensure that any trends identified in appeals are communicated and rectified
Keep abreast of changes in market requirements and demonstrate expert knowledge in specific market nuances
Identify and resolve issues that are unusual and not consistent with standard workflows
Attend client or market meetings as assigned and share any new issues/changes that may be impactful
Establish and maintain professional relationships with Plan contacts
Contact involved provider office to obtain information to properly review the case. Document and summarize member’s and provider’s concerns / issues in a concise and easily readable format
Ensure all letter templates in use are correct and most recent versions are used
Identify areas for improvement or processes that are unproductive, time consuming, and/or inefficient and communicate that information to management
Other duties as assigned
Qualification
Required
High School Diploma or GED required
1+ years experience in healthcare operations or appeals; or related field
Proficient with general computer software including Microsoft Excel, Word and Outlook
Excellent verbal, written, interpersonal, organizational and communication skills
Excellent research skills with ability to identify underlying issue(s) even if not articulated
Ability to remain calm and focused in a high pressure/high workload environment
Ability to work in a high stress environment
Ability to prioritize and organize multiple tasks with tight deadlines
Ability to remain organized with multiple interruptions
Ability to work overtime as needed or required to meet business objectives
Other duties, as assigned as they relate to complaints and grievances
Preferred
Previous experience in claims billing or prior authorizations
Bachelor's degree in business, healthcare or equivalent
Keyboarding skills
Benefits
Generous vacation and sick time
Market-leading 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
Company
Sun Life
Sun Life is a leading financial services organization dedicated to helping people achieve lifetime financial security and live healthier lives.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$1.05B2024-05-13Post Ipo Debt· $548.79M
2023-07-04Post Ipo Debt· $500M
2000-03-24IPO
Leadership Team
Kevin Strain
President & CEO
Luc Nhon Ly
Chief Executive Officer
Recent News
2025-12-02
MarketScreener
2025-12-02
South China Morning Post
2025-11-27
Company data provided by crunchbase