Senior Manager, Absence & Disability Claims

Overview

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.

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Senior Managers provide leadership, guidance and direction to a team of Case Specialists adjudicating Absence (FMLA, PFL/PFML, ADA and other leave programs) and Integrated and/or Standalone Short Term Disability claims. The position is responsible for the service, risk, financial performance, leadership and development of a team of Case Specialists. This role is accountable for Client experience and strong claims management practices which require aligning work practices, performance, and initiatives to reflect the organization s strategic priorities.

• Responsible for the leadership and development of a high performing team
• Oversee and direct the work of a team of 10 - 12 Case Specialists including regular reviews & assessment of team performance against Service and Performance Guarantees.
• Is actively involved in the team s work, setting objectives, creating plans, assigning work, and addressing team performance issues.
• Develop, implement, and evaluate claim practices to deliver best in class service and processes. Ensure uniformity and consistency with all claim practices and procedures.
• Ensure compliance with all relevant laws, regulations, and company policies
• Analyze claims data and trends to identify areas for improvement
• Communicate verbally and in writing with clients, vendors, and internal resources including senior management, in response to inquiries including claimant or case specific statuses, escalated calls or departmental process and performance measures.
• Collaborate with peers and partner teams to deliver on department expectations in support of sales objectives and client service goals.
• Participate and/or lead continuous improvement initiatives or special projects aligned to our KPIs.
• Interprets contracts and ensures consistent, fair claims practices and adherence to appropriate laws, regulations, and procedures.
• Reviews and signs off on claim payments within established limits and/or reviews recommendations made by medical resources to determine proper disposition of claims.
• Protect and maintain personal health information with a high level of confidentiality abiding by Sun Life procedures and by HIPAA rules and regulations.
• Contribute to fraud detection and prevention efforts
• Other duties and responsibilities as assigned.

• Ability to work with a diverse group of people
• A minimum of five years  management experience of an Absence or STD Claims team
• Proven success in developing, building and fostering high performance teams
• Strong Disability and Absence Management knowledge with demonstrated expertise in Federal/State FMLA, short-term disability, statutory disability plans, or ADA.
• Strong leadership skills with an ability to engage employees to deliver top performance related to service, risk and quality
• Able to set direction, monitor performance and initiate and communicate changes in direction as needed.
• Able to build agreement on actions by resolving conflicts in an open and positive manner.
• Demonstrated ability to influence others to achieve results.
• Ability to work professionally and effectively with a diverse group of people.
• Strong organizational skills, including the ability to prioritize work and multi-task.
• Strong research, analytical, critical thinking, problem solving skills and decision-making skills.
• Strong computer skills, proficient in PC environment and MS Word, Excel, and email systems.
• Attention to detail with documentation, reporting and communication.
• Ability and desire to work in a fast-paced, service-oriented environment.
• Excellent verbal and written communication skills, with the ability to be both pleasant and professional.
• Ability to initiate and prioritize regular work duties and projects.
• BA/BS in a related field of business is highly preferred.
• Field or industry specific designations are a plus.

$72,600 - $108,900

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…