Claims Clinical
You are as unique as your background, experience and point of view. Here, youll be encouraged, empowered and challenged to be your best self. Youll 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, youll 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.
Job Description
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
o
pportunity
Sun Life operates with a Work Is Healthy (WisH) approach for disability claims management. As a Clinical Consultant within our Clinical Services team, you will apply your clinical expertise as a member of an interdisciplinary team that focuses on returning clients to optimal levels of productivity. This role does not involve hands-on assessment or direct care. All work is solely performed using electronic medical records and phone/fax communication.
How you will contribute
Conduct comprehensive clinical assessments of disability claims that are referred in different venues.
Clarifies medical information and/or interprets medical reports (IMEs/FCEs, hospital and office records, and health care provider's (HCP) calls and letters) and evaluates restrictions and limitations to assess current and ongoing level of impairment.
Synthesizes pertinent facts and answers questions in collaboration with claims professionals.
Meets standards set by management for quality and performance.
Applies current clinical knowledge to medical data regarding diagnosis, treatment, prognosis, and impairment.
Participates proactively through early assessment of medical conditions, functional capacity, and return to work (RTW) opportunities.
Provides whole person analysis, documenting rationale for opinions and recommended next steps.
Makes appropriate decisions and takes action as indicated to obtain additional medical information and/or referral to the appropriate resource, such as physician, claims professional, or vocational resource.
Provides input and assistance to identify and collect pertinent medical information through outreach communications with attending physicians, claimants/insureds, and employers.
Demonstrates excellent verbal and written communication to gather and report information.
Effectively and accurately educates attending physicians and other health care providers about Sun Life's WisH program.
Operates with urgency to support claims professionals to determine claim direction and facilitate next steps.
Outreach to health care provider (HCP), insured, or as indicated to discuss complex medical issues and document outcomes of discussion.
Coordinates with Vocational Rehabilitation Consultant (VRCs) and others regarding return to work services.
Evaluates each claim file for RTW opportunities and partners with the VRC to develop RTW plans as indicated.
Evaluates claims for potential accommodations or partial RTW.
Partner with VRC to identify functional capabilities for alternative occupations/job duties.
Provides consultation and education to peers and a variety of other business partners.
Demonstrates knowledge, skill, and problem solving in communicating effectively with both internal customers and with external resources.
Works collaboratively with clinical and claims professionals to improve disability claim management practices.
Provides clinical input in claims meetings and leads discussions to facilitate appropriate clinical intervention
.
Provides training and mentoring to new clinical, vocational, claims, and other staff as appropriate.
May provide training to groups of peers and/or claims professionals to update their knowledge/skills.
What you will bring with you
Ability to work with a diverse group of people.
RN licensure, active and unrestricted, BSN preferred
.
Specialty certification such as CCM, CRRN, or eligible with desire to pursue.
3+ years of clinical experience working with an adult working age population.
Experience in a rehabilitation setting, Occupational Health, Case/Care Management, Disability Insurance, Group Benefits, or Workers' compensation a plus.
Ability to communicate effectively and professionally with a wide variety of both internal and external Sun Life business partners, peers, and resources.
Attention to detail with documentation, reporting and communication.
Facilitation skills in a variety of circumstances and with a wide variety of input. Ability to influence and teach.
Self-directed with an ability to work independently and make independent judgments and decisions.
Strong organizational skills, including the ability to prioritize work and multi-task.
Strong research, analytical, critical thinking, problem solving skills and decision-making skills.
Ability to thrive in a fast-paced, service-oriented environment.
Strong computer skills, proficient in PC environment and MS Word, Excel, and email systems
A drive to continuously learn, build, and grow professionally.
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?
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 Globes 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
$77,400 - $116,100
annually
Central region
$81,700 - $122,600
annually
Northern region
$87,300 - $131,000
annually
If you are a Colorado resident
, the salary range for this position is
$73,900 - $110,900 annually.
If you are a New York resident
, the salary range for this position is
$87,300 - $131,000
annually.
If you are Washington resident, the salary range for this position is
$81,700 - $122,600 annually.
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.
#
LI-
remote
to request an accommodation.
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
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.
For applicants residing in California, please read our employee
California Privacy Policy and Notice.
Job Category
Posting End Date
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.