Senior Specialist, Integrated Absence & STD

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.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

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 Case Specialist II, Integrated Absence & STD acts under the general supervision of a Senior Manager managing claims including FMLA, PFL, ADA and/or other leave programs in conjunctions with Short Term Disability (STD) benefits.  This role may take on more complex cases as they develop their ability to analyze and interpret claims. 

How you will contribute: 

The essential functions and responsibilities of this job position include, but are not limited to the following:

• Reviews and investigates disability, FMLA, PFL, ADA and other leave claims thoroughly 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(s)
• Adjudicates claims accurately and fairly in accordance with federal, state, local, and ERISA regulations and the STD contract, appropriate claim policies and procedures, meeting productivity and quality standards
• Utilizes appropriate medical, vocational, 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 or PFL or other 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
• Sends timely appropriate notifications according to communication preferences of claimant and employer
• Coordinates return to work, working with vocational rehabilitation consultant as necessary
• Coordinates placement of needed accommodations for client employees and claimants, working with employer, health care provider, and vocational rehabilitation consultant as needed
• Acts with a sense of urgency in responding to customer inquiries
• Obtains/maintains TPA licensing and required credit hours
• Participates in in-service and training opportunities as required
• Assists with desk coverage and supports peer as available

• Contributes to the development of internal policies and procedures
• Participates in industry or client meetings
• Other duties and responsibilities as needed

What you will bring with you: 

• Ability to work in a self-directed manner in a team environment
• Exposure to various issues within disability and absence product lines
• Solid analytical, critical thinking, problem solving and decision-making skills
• Ability to interpret and communicate disability contract language and FMLA/PFL/ADA and other leave regulation language
• Excellent verbal communication skills, with the ability to be both pleasant and professional
• Strong written communication skills
• Solid mathematical skills
• 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 diverse co-workers, clients, claimants, vendors and others with whom DRMS does business 
• High School Diploma or equivalent
• 1+ years of p