Senior Case Manager I, LTD

Sun Life•Wellesley, MA

3d•$72,500 - $108,800•Hybrid

About The Position

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our 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 and investigation, liability determination, and management of long-term disability claims. The Senior Case Manager I, LTD acts independently and autonomously managing the claim by conducting a thorough review and investigation, determining what additional resources are appropriate to be utilized, and determining the initial and ongoing liability. The Senior Case Manager I, LTD is a more seasoned claims professional and serves as a mentor and resource to less experienced analysts, as well as assists with segment reviews.

Requirements

Minimum 4 years previous related work experience and long-term disability product line experience required
Attains and maintains appropriate TPA licenses in accordance with the Claims Licensing Policy
Demonstrated proficiency with any occupation reviews required
Ability to train and mentor new employees
Ability to work in a self-directed manner with minimal assistance from the lead or manager
Exposure to various issues within a specific disability product line with demonstrated experience in generating and selecting solutions to resolve those issues
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, the ability to multi-task, and strong time management skills
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 with whom FullscopeRMS does business

Responsibilities

Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim
Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line
Utilizes appropriate medical and risk resources, adhering to referral polices, 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, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, cost of living adjustments, etc.
Develops and maintains on-line claim data (and paper file if applicable)
Documents and communicates claim decisions
Coordinates return to work, working with vocational rehabilitation as necessary
As warranted, guides the claims management activities of the insurance company clients’ claims analysts on co-managed claims
Obtains/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
Assists with heavy claim loads
Conducts internal and external claims audits
Conducts internal and external training seminars
Participates in the development of internal policies and procedures
Participates in industry or client meetings
Other duties and responsibilities as requested/needed