Claims Specialist

Reviews and investigates worksite accident, wellness, and screening claims by using 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 (up to six different systems). Resolves eligibility issues by collaborating with employers and partners at the client company. Adjudicates claims and benefits accurately and fairly and in accordance with the contract, appropriate policies and procedures, state and federal regulations, while meeting strict productivity and quality standards. Utilizes clinical staff, adhering to referral policies and transferring claims to the appropriate risk level in a timely manner. Thoroughly reviews all medical records submitted to accurately calculate and communicate all benefits payable in a timely manner.

According to JobzMall, the average salary range for a Claims Specialist in 6 Ashley Dr, Scarborough, ME 04074, USA is $38,000 - $52,000 per year.

Sun Life Financial, Inc. is a diversified financial services company. It provides savings, retirement and pension products, and life and health insurance to individuals and groups through its operations in Canada, the United States, the United Kingdom and Asia. The company operates its business through five segments: Sun Life Financial Canada, Sun Life Financial United States, MFS Investment Management, Inc., Sun Life Financial Asia and Corporate Support.