Senior Manager, Insurance and Claims Advocacy
$76,200–$114,300 year
Hybrid · Kansas City, Missouri, United States or Nashville, Tennessee, United States
Job Summary
Senior Manager, Insurance and Claims Advocacy leads a Clinical Solutions program within PinnacleCare, Sun Life U.S. Health and Risk Solutions, to help members navigate and maximize health insurance while resolving complex medical billing and claim issues. Responsibilities include leading and developing a high-performing Insurance and Claims Advocacy team, owning program strategy and KPIs, overseeing denials/appeals and billing discrepancies, guiding proactive insurance navigation and benefits education, building scalable workflows with data and AI-enabled tools, ensuring audit-ready documentation, and partnering cross-functionally with Sales, Client Service, Member Services, Analytics, and clinical teams to improve member outcomes. The role requires 7+ years in medical billing/claims advocacy, 3+ years of leadership, a Bachelor’s degree, expertise in payer adjudication and CPT/ICD coding, strong negotiation and escalation skills, and proficiency with data/analytics and technology platforms (e.g., Salesforce, MS Office) to drive process improvements.
Required Qualifications
- Bachelor’s degree in healthcare administration, business, or related field required
- 7+ 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)
- 3+ years of progressive people leadership experience, with demonstrated success managing teams and service operations
- Deep knowledge of payer claims adjudication, CPT/ICD coding, and provider billing practices; strong negotiation and escalation management skills
- Proven ability to drive process improvement using data/analytics, technology platforms (e.g., Salesforce, MS Office), and responsible AI-enabled tools
- Excellent communication skills and ability to influence cross-functional stakeholders in a fast-paced environment
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