Case Specialist, Supplemental Health

Sun Life

Case Specialist managing Supplemental Health Claims for Sun Life U.S. Adjudicating Critical Illness, Cancer, Hospital Indemnity and Accidental claims independently and autonomously.

Posted 7/16/2026full-timeBaltimore • Connecticut, Maine, Maryland, Massachusetts, Montana • 🇺🇸 United StatesJunior💰 $55,300 - $83,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in claims adjudication and eligibility investigation, with strong analytical and problem-solving skills. Proficient in interpreting contract language and communicating effectively with various stakeholders.

Highest-signal resume keywords

Claims AdjudicationEligibility InvestigationSupplemental Health ExperienceTPA LicensingAnalytical Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims AnalysisMedical Record ReviewMathematical SkillsContract InterpretationData Management

Soft Skills

Verbal CommunicationWritten CommunicationInterpersonal SkillsTime ManagementDetail Oriented

Tools & Technologies

MS WordMS ExcelPC EnvironmentEmail Systems

Certifications & Qualifications

TPA Licenses

Industry Keywords

Critical Illness ClaimsCancer ClaimsHospital Indemnity ClaimsAccidental ClaimsCustomer Service

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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.

Benefits

Comp & perks

Generous vacation and sick time
Market-leading paid family, parental and adoption leave
Medical coverage
Company paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
401(k) employer match
Stock purchase options
Employer-funded retirement account
Flexible, inclusive and collaborative work environment