Stop Loss & Health Claim Analyst

We need to output HTML fragment with sections: h3 headings for sections present: About the role? The posting includes description of company, but we can treat "About the role" maybe from description? The instruction: use h3 for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). We should include sections only if posting has real specific content. We need to extract content: The posting includes: - Intro about Sun Life (company description). Could be "About the role" or maybe "About the company". But we can put under "About the role" a paragraph summarizing the role? Actually the job description includes "The Opportunity:" and "How you will contribute:" and "What you will bring with you:". Thus sections: Responsibilities (maybe from "The Opportunity:" and "How you will contribute:"), Requirements/Qualifications (from "What you will bring with you:"), Skills (maybe from that list), Benefits (benefits described later), Pay (salary range), Schedule (maybe hybrid work model mentioned). Also maybe "About the role" could be omitted if we have other sections. We must not repeat job title as heading. No Job ID etc. We must remove boilerplate: cookie/navigation/legal/EEO etc. At end there is lots of EEO statements, accommodation, etc. Remove those. We must preserve all substantive information; do not invent or summarize away detail. We need to output only HTML fragment, no /, no markdown fences. Let's extract substantive content: Company description: "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. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities." That's substantive about company; could be placed under "About the role" or maybe "About the company". Since allowed headings include About the role, we can use that. 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." That's schedule/hybrid. "The Opportunity: This position is responsible for reviewing claims, interpreting and comparing contracts, dispersing reimbursement, and ensuring that all claims contain the required documentation to support the Stop Loss claim determination. They are responsible for customer service, and the financial risk associated with an assigned block of Stop Loss claims. This requires applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim. The incumbent is accountable for developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources." That's responsibilities. "How you will contribute:" then bullet list (actually sentences). Let's list them: - Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim - The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions - Maintain claim block and meet departmental production and quality metrics - An awareness of industry claim practices - Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records - Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc. - Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process - Establish cooperative and productive relationships with professional resources These could be responsibilities as well. "What you will bring with you:" list: - A minimum of three to five years’ experience processing first dollar medical claims or stop loss claim processing - Demonstrated ability to work as part of a cohesive team - Strong written and verbal communication skills - Knowledge of Stop Loss Claims and Stop Loss industry preferred - Demonstrated success in negotiation, persuasion, and solutions-based underwriting - Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism - Overall knowledge of health care industry - Proficiency using the Microsoft Office suite of products These are qualifications/requirements/skills. Salary: "Salary: Salary Range: $54,100 - $81,200 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions." That's pay. Benefits: later: "We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds. Life is brighter when you work at Sun Life At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We’re proud to be recognized in our communities as a top employer. Proudly Great Place to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities." That's benefits. Schedule/hybrid: "Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK." That's schedule. We should not include boilerplate like accommodation, EEO, etc. Now produce HTML with sections:

About the role

company description paragraph(s)

Responsibilities

• ... each responsibility

We need to combine responsibilities from "The Opportunity:" and "How you will contribute:" maybe all together. Let's list responsibilities: From The Opportunity: - reviewing claims - interpreting and comparing contracts - dispersing reimbursement - ensuring that all claims contain the required documentation to support the Stop Loss claim determination - responsible for customer service - responsible for the financial risk associated with an assigned block of Stop Loss claims - applying the appropriate contractual provisions; plan specifications of the underlying plan document; professional case management resources; and claims practices, procedures and protocols to the medical facts of each claim to decide on reimbursement or denial of a claim - developing, coordinating and implementing a plan of action for each claim accepted to ensure it is managed effectively and all cost containment initiatives are implemented in conjunction with the clinical resources From How you will contribute: - Determine, on a timely basis, the eligibility of assigned claim by applying the appropriate contractual provisions to the medical facts and specifications of the claim - The ability to apply the appropriate contractual provisions (both from the underlying plan of the policyholder as well as the Sun Life contract) especially with regard to eligibility and exclusions - Maintain claim block and meet departmental production and quality metrics - An awareness of industry claim practices - Prepare written rationale of claim decision based on review of the contractual provisions and plan specifications and the analysis of medical records - Knowledge of legal risk and regulatory/statutory guidelines HIPPA, privacy, Affordable Health Care Act, etc. - Understand where, when and how professional resources both internal and external, e.g. medical, investigative and legal can add value to the process - Establish cooperative and productive relationships with professional resources We could combine but avoid duplication. Some overlap: eligibility etc. We'll keep as separate items but ensure not duplicate. Now Requirements/Qualifications/Skills: maybe separate sections: Requirements and Skills. But we can combine into one "Requirements" or "Qualifications". The instruction says we can use headings like Requirements, Qualifications, Skills. We should only include sections if posting has real specific content. We have both qualifications and skills. Could make two sections: Requirements (experience, teamwork, communication) and Skills (knowledge, negotiation, fast-paced, healthcare industry, MS Office). Or combine. Let's do:

Requirements

• A minimum of three to five years’ experience processing first dollar medical claims or stop loss claim processing
• Demonstrated ability to work as part of a cohesive team
• Strong written and verbal communication skills

Skills

• Knowledge of Stop Loss Claims and Stop Loss industry preferred
• Demonstrated success in negotiation, persuasion, and solutions-based underwriting
• Ability to work in a fast-paced environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
• Overall knowledge of health care industry
• Proficiency using the Microsoft Office suite of products

Now Benefits:

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
• flexible, inclusive and collaborative work environment that supports career growth
• recognized as a top employer (Great Place to Work® Certified in Canada and the U.S.; Top 10 employer by Boston Globe's "Top Places to Work" for two years)

But need to preserve all substantive information; we should not lose details like "generous vacation and sick time" etc. Also mention "We prioritize your well-being with comprehensive benefits, including ..." We can keep as list. Pay:

Pay

Salary Range: $54,100 - $81,200. The actual base salary will be determined based on skills, qualifications, experience, education, and geographic location. Eligible for a discretionary annual incentive award based on individual and business performance.

Schedule:

Schedule

Hybrid work model balancing in-office collaboration with virtual work flexibility in the contiguous states plus AK.

Now About the role: we need to include company description. Could be multiple paragraphs. We'll combine into one

maybe. Let's craft:

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately