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 welcome applicants from anywhere in the U.S.
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:
Short-Term Disability insurance provides an income to employees who cannot work due to an illness or injury. As a Case Specialist, you will review claims for Short-Term Disability and come to the conclusion if the person applying for benefits are eligible to receive them. Some claims are easy, some are more complex. But all claims give you the opportunity to interact and make a difference for our Clients daily.
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 examine 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
Participates in internal and external training seminars
Participates in the development of internal policies and procedures
Participates in industry or client meetings
What you will bring with you:
2+ years of insurance claims experience
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
Solid investigative, 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 on one’s own 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 DRMS 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.
If you are a California resident, the salary range for this position is:
Southern region: $48,100 – 64,900 annually
Central region: $50,700 – 68,400 annually
Northern region: $54,200 – 73,200 annually
If you are a Colorado resident, the salary range for this position is $45,900 – 62,000 annually.
If you are a New York resident, the salary range for this position is $54,200 – 73,200 annually.
If you are Washington resident, the salary range for this position is $50,700 – 68,400 annually.
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:
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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.
