Case Manager I LTD

About the 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.

Responsibilities

• Manage and prioritize a group of claims on an ongoing basis while maintaining appropriate documentation
• Obtain all pertinent and necessary information to evaluate claim credibility
• Prepare written rationale of claim decision based on review of contractual provisions and analysis of medical and occupational records
• Process claims for payment by setting up on claim paying system to ensure accurate and timely receipt of payment benefits
• Assess vocational rehabilitation opportunities by working with vocational staff
• Use investigative tools, may testify in court cases and provide depositions related to claim disputes based on technical expertise
• Manage customer service, the benefit payment process and the financial risk associated with an assigned block of Long Term Disability claims
• Apply the appropriate contractual provisions, legal guidelines, claims procedures and protocols to the facts of each claim to decide on its acceptance or denial and the duration of the benefit payment
• Clearly communicate the rationale with confidence and sensitivity for the claimant’s circumstances

Skills

• Excellent written and verbal communication skills with customer service orientation
• Must be able to work independently and in a team environment
• Ability to conduct detailed claimant interviews
• Solid critical thinking skills as well as the ability to negotiate with people
• Demonstrated expert analytical skills with the ability to think creatively and address the strengths and weaknesses of a claim and the fine distinctions in contract language

Pay

• Salary range: $55,300 - $83,000
• Eligible for a discretionary annual incentive award based on individual performance and overall business performance

Benefits

• Generous vacation and sick time
• Market-leading paid family, parental and adoption leave
• Medical coverage
• Company-paid life and AD&D insurance
• Disability programs
• Partially paid sabbatical program
• 401(k) employer match
• Stock purchase options
• Employer-funded retirement account
• Flexible, inclusive and collaborative work environment that supports career growth
• Recognized as a Great Place to Work® Certified employer in Canada and the U.S.; named a "Top 10" employer by the Boston Globe's "Top Places to Work" for two consecutive years

Schedule

Hybrid work model: team members are expected to be present in the office at least 2 days per week.

Job Category: Claims - Life & Disability • Posting End Date: 08/11/2026