Case Specialist I, STD

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

Job Description:

Location: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work.

The Opportunity: The Case Specialist, STD works under the general supervision of a senior manager and consultant managing claims by conducting thorough reviews and investigation, determining what additional resources are appropriate to be utilized, and determining initial and ongoing liability.

How you will contribute:

• Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim
• Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line
• Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner
• Conducts in-depth pre-existing condition or contestable investigations if applicable
• Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, cost of living adjustments, etc.
• Develops and maintains on-line claim data (and paper file if applicable)
• Documents and communicates claim decisions
• Coordinates return to work, working with vocational rehabilitation as necessary
• As warranted, guides the claims management activities of the insurance company clients’ claims analysts on co-managed claims
• Obtains/maintains TPA licensing and required credit hours
• Participates in in-service and training opportunities as required
• Participates in industry or client meetings
• Other duties and responsibilities as requested/needed

What you will bring with you:

• Minimum 1 year previous work experience required
• Attains and maintains appropriate TPA licenses in accordance with the Claims Licensing Policy
• Solid analytical, critical thinking, problem solving and decision-making skills
• Ability to interpret and communicate disability contract language
• Excellent verbal communication skills, with the ability …