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.  

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work.

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 previous short-term disability and FMLA and/or PFL product line experience required

 Salary Range: $56,100 - $84,200
At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive.  We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate.  We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.  Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.  Enjoy a flexible, inclusive and collaborative work environment that supports career growth.  We’re proud to be recognized in our communities as a top employer.  Proudly Great Place to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.  Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email [email protected] to request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

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.