Senior Case Manager I, LTD

About the company

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. With more than 6,400 employees and associates in partner dental practices, Sun Life operates nationwide. The company is driven by its Purpose: helping Clients achieve lifetime financial security and live healthier lives. Values of caring, authenticity, boldness, inspiration, and impact shape the work environment.

Sun Life embraces a hybrid work model, requiring team members to be present in the office at least 2 days per week to foster connection and teamwork.

About the role

The Senior Case Manager I, LTD conducts the review, investigation, liability determination, and management of long-term disability claims. This role acts independently, managing claims through thorough review, investigation, and determination of ongoing liability. The Senior Case Manager I, LTD serves as a mentor to less experienced analysts and assists with segment reviews.

Responsibilities

• Reviews and investigates disability claims by contacting applicable parties (claimant, employer, treating physician, etc.) to gather pertinent data.
• Adjudicates claims accurately and fairly in accordance with contracts, policies, and state/federal regulations, meeting productivity and quality standards.
• Utilizes medical and risk resources, adheres to referral policies, and transfers claims to appropriate risk levels in a timely manner.
• Conducts in-depth pre-existing condition or contestable investigations if applicable.
• Calculates benefit payments, including partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, and cost-of-living adjustments.
• Develops and maintains online claim data (and paper files if applicable).
• Documents and communicates claim decisions.
• Coordinates return-to-work efforts, working with vocational rehabilitation as necessary.
• Guides claims management activities for insurance company clients’ analysts on co-managed claims.
• Obtains and maintains TPA licensing and required credit hours.
• Participates in in-service and training opportunities.
• Acts as a mentor to new employees, conducting one-on-one training and serving as a resource.
• Assists with segment reviews and heavy claim loads.
• Conducts internal and external claims audits and training seminars.
• Participates in the development of internal policies and procedures.
• Participates in industry or client meetings.
• Performs other duties and responsibilities as requested or needed.

Requirements

• Minimum 4 years of previous related work experience and long-term disability product line experience.
• Attains and maintains appropriate TPA licenses in accordance with the Claims Licensing Policy.
• Demonstrated proficiency with any occupation reviews.
• Ability to train and mentor new employees.
• Ability to work in a self-directed manner with minimal assistance from leads or managers.
• Exposure to various issues within a specific disability product line, with demonstrated experience in generating and selecting solutions.
• Strong analytical, critical thinking, problem-solving, and decision-making skills.
• Ability to interpret and communicate disability contract language.
• Excellent verbal and written communication skills, with a professional and pleasant demeanor.
• 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, with strong time management and multitasking abilities.
• Strong computer skills, proficient in MS Word, Excel, and email systems.
• Ability to work professionally and effectively with coworkers, clients, claimants, vendors, and others.

Pay

The salary range for this role is $72,500 - $108,800. The actual base salary will be determined based on skills, qualifications, experience, education, and geographic location. This position is also eligible for a discretionary annual incentive award based on individual and 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 supporting career growth.