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Case Specialist
Sun Life Financial
Scarborough, ME, United States
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At Sun Life, we work together, share common values and encourage growth and achievement. We offer many career paths that attract a wide variety of talent and skills. Follow a path that lets your talents shine.
Job Description:
At Sun Life, we work together, share common values and encourage growth and achievement. We offer many career paths that attract a wide variety of talent and skills. Follow a path that lets your talents shine.
Job Description:
Sun Life has opportunities available at the Sun Life Center for Healthy Work in Scarborough, Maine!
Come join a fantastic team in a fast paced and exciting work environment. Short Term Disability Claims Associates are responsible for the professional management of both routine and complex claims for Group Short Term Disability. Works both independently and in a team to ensure superior service to policyholders and claimants. Reviews claims and makes final determination for admittance or denial. Approves payment of claims and Company liability within established limits.
Main Accountabilities
• Reviews claim payments within established limits and/or reviews recommendations made by medical resources to determine proper disposition of claims
• Sets claim action plan to ensure that determinations are adjudicated in a timely, accurate, and efficient manner
• Interprets contracts and ensures consistent, fair claims practices and adherence to appropriate laws, regulations, and procedures
• Obtains backup documentation, as necessary, to substantiate claim or to provide service by communicating via telephone with agents, employers (policyholders), claimants, hospitals, physicians, attorneys, and other resources
• May handle other related duties such as providing technical assistance to other Claims staff or assisting in special projects or assignments as a result of business needs
Requirements
• Disability claims management experience strongly preferred
• Associate or Bachelor degree preferred
• Proficiency in MS Office Outlook, Word, Excel, PowerPoint and Windows 7 with the ability to learn new and complex computer systems
Skills/Knowledge
• Strong mathematical skills for calculations and adjustment of claim payments
• Requires independent judgment to settle claims in accordance with policy provisions
• Must be able to utilize legal resources and demonstrate a proven ability to comprehend and interpret legal and medical terminology in order to make final decisions to approve or further investigate claims
• Excellent organization skills required due to the nature of internal and external contacts and exposure to highly confidential information
• Strong customer service focus
• Strong analytical and problem solving skills
• Proven ability to successfully cope in a fast-paced, demanding environment
• Proven ability to work independently on own initiative and in a team environment
• Excellent written and verbal communication and interpersonal skills
• Demonstrated ability to work to deadlines with a high level of accuracy and attention to detail
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.
Job Category:Claims - Life & Disability
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