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Administrator
Sun Life Financial
South Portland, 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:
PTD Administrator
Under direct supervision, the PTD Administrator manages the maintenance of Permanent and Totally Disabled (PTD) claims, generated from multiple products (e.g., ASC, LTD, STD with long duration and Life Waiver) that are stable and mature.
The essential functions and responsibilities of this job position include, but are not limited to the following:
• Manages the maintenance of a caseload of >2100 open (PTD) claims that are stable and mature (initial liability, as well as benefit calculations, including known offsets, are determined by a Managed Disability Analyst)
• Uses telephone and written contact with the Claimant, Treating Physician, and employer on a 12-24 month basis to gather pertinent data to determine ongoing liability
• Appropriately refers the claim to a Managed Disability Analyst if red flags or new data warrants it
• Using multiple policies from multiple clients, applies the appropriate contractual provisions; legal guidelines; case management resources; and claim procedures, concepts, principles, and protocols to appropriately manage claims from both a durational and financial standpoint
• Ensures benefit payments are sent on a timely basis – both payment adjustments transactions (pats) and checks
• Calculates cost of living increases
• Ensures survivor benefits are calculated timely and accurately
• Calculates, communicates and collects overpayments resulting from:
◦ Change in Social Security (SS) offsets due to dependent benefits ending
◦ Change in SS offsets due to credits for additional earnings
◦ Change in Workers compensation offsets
◦ Change in Pension offsets
◦ Change in 3rd Party Lawsuit offsets
• Identifies and refers claimants potentially eligible for Veteran’s Benefits to appropriate vendor
• Refers appropriate claims for settlement review
• Maintains claim file and on-line claim data
• Maintains ERISA compliance where the claim is governed by ERISA
• Communicates with Managed Disability Analyst, client companies and finance to resolve reimbursement discrepancies
• Complies with applicable state law in the management and adjudication of all claims
• Participates in industry meetings
• Other duties and responsibilities as requested/needed
Position Requirements and Qualifications:
• Minimum 1 year previous related work experience preferred
• Ability to interpret and communicate disability contract language
• Ability and desire to work in a fast-paced, service-oriented environment
• 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 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 business
Sun Life Financial (U.S.) Services Company, Inc. is a federal contractor subject to Executive Order 11246, Section 4212 of the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended, and Section 503 of the Rehabilitation Act of 1973, as amended. As such the company is committed to taking positive steps to implement the employment-related aspects of the company’s equal employment opportunity policy. It is the company’s policy to take affirmative action to employ, advance in employment, and otherwise treat qualified minorities, females, protected veterans, and individuals with disabilities without regard to their race/ethnicity, sex, veteran status, or disability.
Pursuant to 41 CFR §§ 60-300.44(f)(1)(ii) and 741.44(f)(1)(ii), we hereby notify you of our company policy related to our affirmative action efforts and request appropriate action on your part.
Job Category:Claims - Life & Disability
Posting End Date:30/01/2019