Case Specialist, Supplemental Health

Job Description 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 in-depth pre-existing 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 decision‑making 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 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 FullscopeRMS does business Salary Range Salary Range: $55,300 - $83,000 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. Benefits 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. Accommodation We will make reasonable accommodations to the known physical or mental limitation(s) 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 View email address on click.appcast.io to request an accommodation. EEO & Diverse Hiring Statement 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. Job Category Claims - Life & Disability Posting End Date 13/08/2026 #J-18808-Ljbffr Sun Life