Billing Advocate Associate

About the role

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. At Sun Life, we're driven by our Purpose: helping our Clients achieve lifetime financial security and live healthier lives. Our values shape how we work: caring, authentic, bold, inspiring, and impactful. When you join Sun Life, you'll work with passionate colleagues and empowering leaders who support your growth and celebrate your contributions, so you can make a meaningful difference in our Clients' lives. The Insurance Claims Advocate is a vital member of the Insurance Claims Advocacy Team (ICAT) at PinnacleCare, Sun Life U.S. Health and Risk Solutions. This non-exempt, non-management position delivers expert medical billing advocacy and insurance claims resolution. The Advocate provides high-touch, end-to-end member support through all Insurance Claims Advocacy products and acts as a subject matter expert contributing to operational excellence.

Responsibilities

• Investigate and resolve unpaid, underpaid, or denied claims through diligent follow-up, escalation, and appeals, ensuring accuracy in audits of medical bills, Explanation of Benefits, and payment histories.
• Track and submit out-of-network claims, identify errors, coding issues, or coverage mismatches.
• Reduce member out-of-pocket costs through correction-claims and coordination of benefits.
• Serve as a knowledgeable representative/mediator among members, providers, and insurance carriers, communicating professionally and clearly on the member’s behalf.
• Document all claim activities, interactions, and recommendations thoroughly in Salesforce, aligning with departmental Standard Operating Procedures.
• Utilize Microsoft Office Suite (Excel for tracking, Word for appeals and summaries, Outlook for communications), PDF/document management tools for review and annotation, and insurance carrier portals/call systems for status checks and escalations.
• Maintain basic medical coding familiarity (CPT/HCPCS/ICD).
• Deliver consistent, quality advocacy services across all Insurance Claims Advocacy products, acting as a resource and escalation point for complex cases.
• Mentor new hires, lead onboarding and cross-training, and conduct periodic case reviews for skill development and adherence to policies.
• Assist in drafting, reviewing, and refining SOPs; support data collection and analysis for performance metrics; and collaborate on identifying and addressing process gaps or improvements.

Qualifications

• Experience in health insurance, medical billing, or insurance advocacy.
• Proven expertise in medical billing audits, appeals, and coordination of benefits.
• Exceptional verbal, written, and interpersonal communication skills.
• Excellent organizational and prioritization skills; able to manage multiple member matters simultaneously.
• Computer proficiency in MS Office, Adobe or similar document management tool, and carrier/plan portal proficiency.
• Salesforce experience preferred.
• Ability to handle sensitive situations with diplomacy