Senior Case Manager I, LTD at Sun Life Financial (U.S.) Services Company, Inc. — Portland, ME

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
• 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
• Strong 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 FullscopeRMS does business

Salary Range: $72,500 - $108,800

Job Category:

Claims - Life & Disability

Posting End Date:

31/08/2026