Senior Specialist, Integrated Absence & STD Position Available In Cumberland, Maine

Senior Specialist, Integrated Absence & STD at Sun Life Financial (U.S.) Services Company, Inc. in South 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 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… 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.