Case Specialist, Supplemental Health

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: We support US flexible working arrangements in the contiguous 48 states.  

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America. 

The opportunity: 

The Case Specialist, Supplement Health Claims manages initial liability claims submitted for Critical Illness, Cancer, Hospital Indemnity and Accidental claims. They work independently and autonomously managing each claim by conducting a thorough review and investigation, determining what additional resources are appropriate to collaborate with and deciding the initial and future liability of each claim.

How you will contribute: 

• Reviews and investigates Critical Illness, Cancer, Hospital Indemnity and Accidental claims by using the telephone and written contact with the applicable parties, e.g. claimant, employer, treating physicians and client carrier partner, to gather pertinent data to analyze each claim.

• Investigates the claim level eligibility by accessing the client carriers’ systems.

• Resolves eligibility issues by collaborating with employers and partners at the client company.

• Adjudicates claims and benefits accurately and fairly, in accordance with the contract, appropriate policies and procedures, and state and federal regulations, while meeting productivity and quality standards.

• Utilizes clinical staff, adhering to referral policies.

• Conducts in-depth pre-existing condition reviews and contestable investigations.

• Thoroughly reviews all medical records and additional information submitted to accurately calculate and communicate all benefits payable in a timely manner.

• Develops and maintains online claims data.

• Interprets, understands, and communicates the policy that governs each claim.

• Mentors and trains new hires as requested.

What you will bring with you: 

• Minimum 1-year previous work experience in financial, medical, and/or customer service field

• High School Diploma required; college degree preferred

• Experience in Supplemental Health, Case Administrator role preferred 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 contract language

• Excellent verbal communication skills, with the ability to be both pleasant and professional

• Strong written communication skills

• Solid mathematical skills

• Ability to work well independently and in a team environment

• Strong interpersonal and customer service skills

• Ability to initiate and prioritize regular work duties and projects

• 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

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

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. 

Salary Range: $54,900 - $82,400

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.

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 recruitingUS@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.

Job Category:

Posting End Date:

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.