Senior Case Manager I, LTD

About this role

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.  

Job Description:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week. ​

The Senior Case Manager I, LTD conducts the review and investigation, liability determination, and management of long-term disability claims.  The Senior Case Manager I, LTD acts independently and autonomously managing the claim by conducting a thorough review and investigation, determining what additional resources are appropriate to be utilized, and determining the initial and ongoing liability.  The Senior Case Manager I, LTD is a more seasoned claims professional and serves as a mentor and resource to less experienced analysts, as well as assists with segment reviews.

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

• 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

• 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 bring with you: • Minimum 4 years previous related work experience and  long-term disability product line experience required

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

• Demonstrated proficiency with any occupation reviews required

• Ability to train and mentor new employees

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

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

• Strong 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

• 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

Salary Range: $72,500 - $108,800

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.

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