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 Manager I, Integrated Absence & STD acts under the general supervision of a Senior Manager managing claims by conducting thorough reviews and investigation, determining what additional resources are needed, sending timely appropriate notifications, adhering to applicable state, federal, local, and ERISA regulations, STD policy provisions, determining eligibility and benefits for FMLA, PFL, ADA and other leave programs, and determining initial and ongoing liability of STD claims.

How you will contribute:

• Reviews and investigates STD, FMLA, PFL, ADA and other leave claims by using telephone and written contact with the applicable parties (claimant, employer/supervisor, treating physician, etc.) to gather pertinent data to review the claim(s)

• Adjudicates claims accurately and fairly in accordance with federal/state/local regulations, and the STD contract, appropriate claim policies and procedures, meeting productivity and quality standards

• Expertly manages a complex case load managing risk and making appropriate conclusions

• Provides technical coaching to peers and supports their professional development

• Works collaboratively with managers and senior consultants throughout the department to provide technical assistance and problem-solving strategies

• Is considered an expert within the department. Takes the initiative to problem solve as needed. This might include educating the field force on claim philosophy and collaborating with the management team

• Recognizes the value of idea sharing within the industry and has presented to peers

• Understands early intervention and can identify claims that have a high likelihood of RTW with Case Management intervention

• Adheres to STD business process model to identify early resolution claims

• Has the ability to properly execute complex written correspondence in a manner that meets legal guidelines and yet is understood by the recipient.

• Identifies claims for automatic transfer to LTD versus claims requiring additional medical documentation prior to transferring to LTD

• Assists in assuring team adherence to ERISA, SOX, Privacy, and/or statutory requirements.

• 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

• Documents and communicates claim conclusions

• 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

• Participates in in-service and training opportunities as required

• Obtains/maintains TPA licensing and required credit hours

• Assists with heavy claim loads, segment reviews, and audits

• Participates in the development of internal policies and procedures

• Participates in industry or client meetings

What you will bring with you:

• 3+ years previous STD claims experience

• 1+ year experience FMLA and/or PFL

• Exposure to various issues within STD, FMLA and/or PFL with demonstrated experience in generating and selecting solutions to resolve those issues

• Solid analytical, critical thinking, problem solving and decision-making skills

• Ability to interpret and communicate STD and FMLA/PFL/ADA and other leave regulation language

• Effectively adapts to change within the organization, department, and industry

• Exceptional grasp of highly complex STD claim practices

• Actions are determined by drawing upon expert STD knowledge base, highly developed skills, and decision-making ability

• Works under consultative direction, but for the most part can make judgements on one’s own initiative.

• Demonstrated ability to take the initiative to handle problems that arise within the department and step in if a situation arises to effect resolution

• Committed to lifelong learning and personal career planning

• Excellent written and verbal communication skills, with the ability to be both friendly and professional

• 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 DRMS 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. If you think you might thrive in this setting, we would love to hear from you.

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!

Life is brighter when you work at Sun Life

• Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical, and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid 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 employer-paid match as well as an employer-funded 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: $61,700 – 92,600 annually

• Central region: $65,000 – 97,500 annually

• Northern region: $69,500 – 104,300 annually

If you are a Colorado resident, the salary range for this position is $58,900 – 88,400 annually.

If you are a New York resident, the salary range for this position is $69,500 – 104,300 annually.

If you are Washington resident, the salary range for this position is $65,000 – 97,500 annually.

• The full range minimum and maximum listed in the job posting is tied to the GCF level and job family.

We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.

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.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

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Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation 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 recruitingUS@sunlife.com to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

Absence / Leave Management

26/12/2023

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.