Case Specialist II, 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:

Come join a fantastic team in a fast paced and exciting work environment! 

What you will do:

The Case Specialist, STD acts 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.

The essential functions and responsibilities of this job position include, but are not limited to the following:

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

• Acts as a mentor to new employees, conducting one-on-one training and serving as a resource

• Assists with segment reviews

• Assists with heavy claim loads

ADDITIONAL RESPONSIBILITIES:

• Conducts internal and external claims audits

• Conducts internal and external training seminars

• Participates in the development of internal policies and procedures

• Participates in industry or client meetings

• Other duties and responsibilities as requested/needed

What you will need to succeed:

• Attains and maintains appropriate TPA licenses in accordance with the Claims Licensing Policy

• Ability to train and mentor new employees

• Ability to work in self-directed manner with minimal assistance from the consultant or manager

• Exposure to various issues within specific disability product line with demonstrated experience in generating and selecting solutions to resolve those issues

• Ability to work professionally and effectively with co-workers, clients, claimants, vendors and others with whom DRMS does business

• Ability to initiate and prioritize regular work duties and projects

• Ability to work well independently and in a team environment

Required Education and Skills:

Minimum 2 years previous related work experience and short-term disability product line experience required.

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 to be both pleasant and professional.

Strong written communication skills, solid mathematical skills.

Strong interpersonal and customer service skills.

Detail oriented, organized, the ability to multi-task, and strong time management skills.

Strong computer skills, proficient in a PC environment and MS Word, Excel, and email systems.

What is in it for you?

Excellent benefits with generous vacation and sick time, 401K match, noncontributory retirement plan, Paid Family Medical Leave, sabbatical program and much more, friendly, collaborative and inclusive culture.

Our agile work environment allows our employees the flexibility to give and feel their best at work.

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you. 

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! 

Life is brighter when you work at Sun Life 

•  Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical, and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more 

• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account  

•  A flexible work environment with a friendly, caring, collaborative and inclusive culture  

•  Great Place to Work® Certified in Canada and the U.S.  

•  Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running 

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. 

If you are a California resident, the salary range for this position is:  

• Southern California region: $55,900-75,500 - $max annually 

• Central California region: $55,900-- $75,500 annually 

• Northern California region: $59,700 - $80, annually 

If you are a Minnesota, Colorado or Nevada resident, the salary range for this position is $50,600 - $68,300 annually 

If you are a Illinois, Connecticut or Maryland resident, the salary range for this position is $53,000 - $71,600 annually 

If you are Washington, Washington D.C., and Rhode Island resident, the salary range for this position is $55,900 - $75,500 annually 

If you are a New York resident, the salary range for this position is $55,900 - $75,500 annually 

The full range minimum and maximum listed in the job posting is tied to the GCF level and job family. 

We consider various factors in determining actual pay including your skills, qualifications, and experience.  In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits. 

Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more. 

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.  

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Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.com to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.