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.

At Sun Life, we're driven by our Purpose: helping our Clients achieve lifetime financial security and live healthier lives. Our values—caring, authentic, bold, inspiring, and impactful—shape how we work. When you join Sun Life, you'll collaborate with passionate colleagues and empowering leaders who support your growth and celebrate your contributions.

About the Role

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. 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, investigation, liability determination, and management of long-term disability claims. This role acts independently and autonomously, managing claims through thorough review and investigation, determining appropriate resources, and assessing initial and 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 using telephone and written contact with applicable parties (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data and analyze the claim.
• Adjudicates claims accurately and fairly in accordance with the contract, claim policies and procedures, and state and federal regulations, meeting productivity and quality standards.
• Utilizes appropriate medical and risk resources, adhering to referral policies, 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, 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 the claims management activities of insurance company clients’ claims analysts on co-managed claims.
• Obtains and 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 and heavy claim loads.
• Conducts internal and external claims audits and training seminars.
• Participates in the development of internal policies and procedures and 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 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, with strong time management and multitasking abilities.
• 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.

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 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 supporting career growth.