Senior Case Manager I, LTD at Sunlife

Job description

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. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. At Sun Life, we're driven by our Purpose: helping our Clients achieve lifetime financial security and live healthier lives. Our values shape how we work: caring, authentic, bold, inspiring, and impactful. When you join Sun Life, you'll work with passionate colleagues and empowering leaders who support your growth and celebrate your contributions, so you can make a meaningful difference in our Clients' lives. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. Job Description: 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. How you will contribute: 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 What you will bring with you: 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 Abi