Case Manager, I

Sun Life•Portland, ME

20h

About The Position

The Case Manager works under the general supervision of a senior manager and consultant to manage disability claims. The role involves reviewing and investigating claims, gathering information from relevant parties, assessing liability, applying contract terms and applicable policies and regulations, and determining appropriate resources. The position also documents and communicates claim decisions, calculates benefits, and coordinates return-to-work efforts. The posting describes the role as “Case Manager, I” in its title but refers to “Case Manager, II, STD” in the job description.

Requirements

Minimum of 3 years of previous work experience.
Attain and maintain appropriate TPA licenses in accordance with the Claims Licensing Policy.
In-depth analytical, critical-thinking, problem-solving, and decision-making skills.
In-depth knowledge of medical terminology and conditions.
Ability to interpret and communicate disability contract language.
Excellent verbal communication skills and the ability to be pleasant and professional.
Strong written communication skills.
Solid mathematical skills.
Ability to work independently and in a team environment.
Strong interpersonal and customer service skills.
Ability to initiate and prioritize regular work duties and projects.
Detail-oriented and organized, with the ability to multitask and strong time-management skills.
Strong computer skills, including proficiency in a PC environment, MS Word, Excel, and email systems.
Ability to work professionally and effectively with coworkers, clients, claimants, vendors, and others.

Responsibilities

Review and investigate disability claims through telephone and written contact with claimants, employers or supervisors, treating physicians, and other applicable parties.
Adjudicate claims accurately and fairly in accordance with contracts, claim policies and procedures, and state and federal regulations, while meeting productivity and quality standards.
Use appropriate medical and risk resources, follow referral policies, and transfer claims to the appropriate risk level in a timely manner.
Conduct in-depth pre-existing condition or contestable investigations when applicable.
Calculate benefit payments, including partial disability, integration with other income sources, survivor benefits, residual disability benefits, and cost-of-living adjustments.
Develop and maintain thorough claim documentation.
Document and communicate claim decisions.
Coordinate return-to-work efforts, working with vocational rehabilitation as necessary.
Guide insurance company clients’ claims analysts on co-managed claims when warranted.
Work collaboratively with managers and senior consultants to provide technical assistance and problem-solving strategies.
Participate in industry or client meetings.
Perform other duties and responsibilities as requested or needed.

Benefits

Generous vacation and sick time.
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.