Senior Case Manager I LTD

FullscopeRMS helps health plans and insurance carriers grow their businesses with our turn-key solutions for group life & disability, absence management, supplement health and medical stop-loss products. We are a subsidiary of Sun Life, a leading provider of group insurance benefits in the U.S.. FullscopeRMS also provides group life and disability plans to our clients through the third-party administrator Disability Reinsurance Management Services, Inc., often referred to as DRMS. Job Description: Location: We support US flexible working arrangements in the contiguous 48 states. At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America. The opportunity: The Senior Case Manager I, LTD manages claims by conducting a thorough review and investigation, determining what additional resources are appropriate to be utilized, and deciding the initial and ongoing liability. How you will contribute: Gathers pertinent claim information, investigates, and adjudicates disability claims by using telephone and written contact with applicable parties (claimant, client, employer/supervisor, treating physician, etc.) Demonstrates timely and effective utilization of claims support resources, vendors, and tools and understands the role each plays in the management of claims 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 Demonstrates mastery of the claims system effectively using online tools to organize, track, prioritize and refer work while maintaining integrity of claims data Documents and communicates claim discussions and resolutions Appropriately prioritizes work; anticipates and manages workload and other job requirements effectively Demonstrates solid understanding of the reinsurance business model Demonstrates carrier/client understanding, applies client specifics accurately and executes appropriate client brand protection Participates in in-service and training opportunities as requires Guides the claims management activities of the insurance company clients’ claim analysts on co-managed claims, as warranted Serves as a mentor and resource to less experienced case managers Assists with segment reviews Assists with excess 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 What you will bring with you: 4 years previous related work experience Specific disability product line experience required In-depth understanding of highly complex claims practices, keeps current with industry practices, and contributes to evolving claim management techniques Actions determined by drawing upon comprehensive knowledge base and highly developed skills. Situations range from less complex to highly complex, often presenting unique circumstances Ability to 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 Maintains appropriate TPA license in accordance with Claims Licensing Policy Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! Life is brighter when you work at Sun Life 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 running All 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 California resident, the salary range for this position is: Southern region: $75,800 – 113,700 annually Central region: $79,900 – 119,200 annually Northern region: $85,400 – 128,100 annually If you are a Colorado or Nevada resident, the salary range for this position is $72,300 – 108,500 annually. If you are a Connecticut or Maryland resident, the salary range for this position is $75,800 – 113,700 annually. If you are Washington or Rhode Island resident, the salary range for this position is $79,900 – 119,200 annually. If you are a New York resident, the salary range for this position is $85,400 – 128,100 annually. The full range minimum and maximum listed in the job posting is tied to the GCF level and job family. 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. At 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. #LI-remote For applicants residing in California, please read our employee California Privacy Policy and Notice. Job Category: Claims - Life & Disability Posting End Date: 06/06/2024 FullscopeRMS helps health plans and insurance carriers grow their businesses with our turnkey solutions for group life & disability, absence management, supplement health and medical stop-loss products. We are a subsidiary of Sun Life, a leading provider of group insurance benefits in the U.S. FullscopeRMS also provides group life and disability plans to our client partners through the third-party administrator Disability Reinsurance Management Services, Inc., often referred to as DRMS. We're partner-focused As a strategic partner, we value our long-standing client partners, and look forward to developing new relationships. We are always looking for new solutions to expand our offerings in this growing market. We're highly engaged We are a collaborative team of nearly 500 professionals with specialized skills to thrive in today's complex risk protection industry. Our leaders will inspire you to perform your best while growing, innovating, and working together to achieve success. We're an exceptional employer We support an inclusive and diverse environment where you can bring your authentic self to work each day. We offer competitive pay, benefits and rewards programs, flexible work schedules, and more.

Salary : $79,900 - $85,400