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Case Specialist III, STD

Company: Sun Life Financial
Location: Portland
Posted on: January 27, 2023

Job Description:

You are as unique as your background, experience and point of view. Here, you'll 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.Job Description: Short-Term Disability insurance provides an income to employees who cannot work due to an illness or injury. As a Case Specialist, you will review claims for Short-Term Disability and decide if the person applying for benefits are eligible to receive them. Some claims are easy, some are more complex. But all claims give you the opportunity to interact and make a difference for our Clients daily.What you will do:

  • 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
  • Participates in internal and external training seminars
  • Participates in the development of internal policies and procedures
  • Participates in industry or client meetingsWhat you will need to succeed:
    • Attains and maintains appropriate TPA licenses in accordance with the Claims Licensing Policy
    • Ability to train and mentor new employees
    • Ability to work in self-directed manner with minimal assistance from the consultant or manager
    • Exposure to various issues within specific disability product line with demonstrated experience in generating and selecting solutions to resolve those issues
    • Solid 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 DRMS does businessRequired Education and Skills: -
      • 2+ years of insurance claims experience.What is in it for you?
        • Excellent benefits and wellness programs to support the three pillars of your well-being - mental, physical, and financial - 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 more
        • Retirement 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 account
        • A flexible work environment with a friendly, caring, collaborative and inclusive culture
        • Great Place to Work - Certified in Canada and the U.S.
        • Named as a "Top 10" employer by the Boston Globe's "Top Places to Work" 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 Colorado resident, the salary range for this position is $45.,900-$62,000 annually.If you are a New York resident, the salary range for this position is $54,200-$73,200 annually. 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.#LIremoteAt 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 employee .Job Category: Claims - Life & DisabilityPosting End Date:

Keywords: Sun Life Financial, Portland , Case Specialist III, STD, Other , Portland, Oregon

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