Job Description

You are as unique as your background, experience and point of view. Here, you\xe2\x80\x99ll 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.:Location: We support US flexible working arrangements in the contiguous 48 states.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\xe2\x80\x99ll 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:The Case Specialist, Supplement Health Claims manages initial liability claims submitted for Critical Illness, Cancer, Hospital Indemnity and Accidental claims. They work independently and autonomously managing each claim by conducting a thorough review and investigation, determining what additional resources are appropriate to collaborate with and deciding the initial and future liability of each claim.How you will contribute:Reviews and investigates Critical Illness, Cancer, Hospital Indemnity and Accidental claims by using the telephone and written contact with the applicable parties, e.g. claimant, employer, treating physicians and client carrier partner, to gather pertinent data to analyze each claim.Investigates the claim level eligibility by accessing the client carriers\xe2\x80\x99 systems.Resolves eligibility issues by collaborating with employers and partners at the client company.Adjudicates claims and benefits accurately and fairly, in accordance with the contract, appropriate policies and procedures, and state and federal regulations, while meeting productivity and quality standards.Utilizes clinical staff, adhering to referral policies.Conducts in-depth pre-existing condition reviews and contestable investigations.Thoroughly reviews all medical records and additional information submitted to accurately calculate and communicate all benefits payable in a timely manner.Develops and maintains online claims data.Interprets, understands, and communicates the policy that governs each claim.Mentors and trains new hires as requested.What you will bring with you:Minimum 1-year previous work experience in financial, medical, and/or customer service fieldHigh School Diploma required; college degree preferredExperience in Supplemental Health, Case Administrator role preferred Attains and maintains appropriate TPA licenses in accordance with the Claims Licensing PolicySolid analytical, critical thinking, problem solving and decision-making skillsAbility to interpret and communicate contract languageExcellent verbal communication skills, with the ability to be both pleasant and professionalStrong written communication skillsSolid mathematical skillsAbility to work well independently and in a team environmentStrong interpersonal and customer service skillsAbility to initiate and prioritize regular work duties and projectsDetail oriented, organized, the ability to multi-task, and strong time management skillsStrong computer skills, proficient in a PC environment and MS Word, Excel, and email systemsAbility to work professionally and effectively with co-workers, clients, claimants, vendors, and others with whom FullscopeRMS does businessDo you see yourself in this role even if you haven\xe2\x80\x99t 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? to stay connected until the time is right for you!Life is brighter when you work at Sun LifeExcellent benefits and wellness programs to support the three pillars of your well-being \xe2\x80\x93 mental, physical, and financial \xe2\x80\x93 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 moreRetirement 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 accountA flexible work environment with a friendly, caring, collaborative and inclusive cultureGreat Place to Work\xc2\xae Certified in Canada and the U.S.Named as a \xe2\x80\x9cTop 10\xe2\x80\x9d employer by the Boston Globe\'s \xe2\x80\x9cTop Places to Work\xe2\x80\x9d two years runningAll 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: $58,300 \xe2\x80\x93 87,500 annuallyCentral region: $61,500 \xe2\x80\x93 92,300 annuallyNorthern region: $65,800 \xe2\x80\x93 98,700 annuallyIf you are a Minnesota, Colorado, or Nevada resident, the salary range for this position is $55,700 \xe2\x80\x93 83,600 annuallyIf you are an Illinois, Connecticut, or Maryland resident, the salary range for this position is $58,300 \xe2\x80\x93 87,500 annuallyIf you are a New York resident, the salary range for this position is $65,800 \xe2\x80\x93 98,700 annually.If you are Washington, Washington D.C., or Rhode Island resident, the salary range for this position is $61,500 \xe2\x80\x93 92,300 annuallyThe full range minimum and maximum listed in the job posting is tied to the GCF level and job family.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.#LI-remoteOur 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 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 employeeJob Category: Claims - Life & DisabilityPosting End Date: 20/10/2024All 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.

Sun Life Financial