Case Specialist, Supplemental Health - Portland, United States - Sun Life

Sun Life
Sun Life
Verified Company
Portland, United States

4 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description
You are as unique as your background, experience and point of view. Here, you'll be encouraged, empowered and challenged to be your best self.

You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you.

Your leaders will inspire and help you reach your potential and soar to new heights.

Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do.

Discover how you can make a difference in the lives of individuals, families and communities around the world.


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, 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 indepth preexisting 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 decisionmaking 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 multitask, and strong time management skills
  • Ability to work professionally and effectively with coworkers, clients, claimants, vendors, and others with whom FullscopeRMS does business

Life is brighter when you work at Sun Life

  • Excellent benefits and wellness programs to support the three pillars of your wellbeing mental, physical, and financial including generous vacation and sick time, marketleading paid family, parental and adoption leave, a partiallypaid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
  • Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employerpaid match as well as an employerfunded retirement account
  • A flexible work environment with a friendly, caring, collaborative and inclusive culture
  • Great Place to Work Certified in Canada and the U.S.
  • Named as a "Top 10" employer by the Boston Globe's "Top Places to Work" two years running


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.


  • If you are a California resident, the salary range for this position is:_
- _ Southern region: _
_$58, ,500 __annually_
- _ Central region: _**_$61, ,300_
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