Case Specialist, Supplemental Health Position Available In Cumberland, Maine

Case Specialist, Supplemental Health at Sun Life Financial (U.S.) Services Company, Inc. in Portland, Maine, United States Job Description 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 ourClients.

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 challengedbyworking withdynamic colleaguesto find new and innovative ways to make Sun Life the best benefits company in America.
The opportunity:
The Case Specialist, Supplement Health Claims manages initial liability claims submitted for Critical Illness, Cancer, Hospital Indemnity and Accidental claims. They work independently and autonomously managing each claim by conducting a thorough review and investigation, determining what additional resources are appropriate to collaborate with and deciding the initial and future liability of each claim.
How you will contribute:
Reviews and investigates Critical Illness, Cancer, Hospital Indemnity and Accidental claims by using the telephone and written contact with the applicable parties, e.g. claimant, employer, treating physicians and client carrier partner, to gather pertinent data to analyze each claim.
Investigates the claim level eligibility by accessing the client carriers’ systems.
Resolves eligibility issues by collaborating with employers and partners at the client company.
Adjudicates claims and benefits accurately and fairly, in accordance with the contract, appropriate policies and procedures, and state and federal regulations, while meeting productivity and quality standards.
Utilizes clinical staff, adhering to referral policies.
Conducts in-depth pre-existing condition reviews and contestable investigations.
Thoroughly reviews all medical records and additional information submitted to accurately calculate and communicate all benefits payable in a timely manner.
Develops and maintains online claims data.
Interprets, understands, and communicates the policy that governs each claim.
Mentors and trains new hires as requested.
What you will bring with you:
Minimum 1-year previous work experience in financial, medical, and/or customer service field
High School Diploma required; college degree preferred
Experience in Supplemental Health, Case Administrator role preferred Attains and maintains appropriate TPA licenses in accordance with the Claims Licensing Policy
Solid analytical, critical thinking, problem solving and decision-making skills
Ability to interpret and communicate 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
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…. For full info follow application link. Sun Life Financial is an equal employment and affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status or any other characteristic protected by law. Sun Life Financial is committed to building a diverse and inclusive company culture. 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.