You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll 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, you'll 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.
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 opportunity:
The Senior Clinical Consultant is responsible for the enhancement of FullScope RMS’ claims management by serving as medical consultative resource. Responsibilities include the review of clinical records and communications with providers and other parties to facilitate the clinical aspects of claim management and benefits determination process.
How you will contribute:
Performs a critical review and analysis of medical information with regard to diagnosis, treatment, prognosis and duration of the conditions, forms a conclusion, and clearly communicates the rationale
Completes written and verbal consultations with all levels of the claims staff that will clearly outline the answers on functional parameters as well as the length and severity of the medical condition(s)
Holds “walk in” consultation meetings with claims staff regarding disability claims, capturing essential elements of a file
Ensures quality investigations of medical information utilizing the resources available
Reviews and evaluates Independent Medical Examination (IME) reports and Functional Capacity Evaluation (FCE) reports
Helps claims staff increase knowledge of medical terminology and conditions through training and feedback
Assists with the development of return-to-work plans
Maintains knowledge and skills regarding medical advances and communicates/educates claims staff in one-on-one meetings
Continues to research rare/unusual medical conditions and be knowledgeable on the tools necessary to perform this research
Communicates verbally and in writing with providers, subscribers and other appropriate contacts in a professional and effective manner, resolving discrepancies and clarifying medical information, including diagnosis, treatment, prognosis, restrictions, limitations, and duration of conditions
Participates in triage and multi-disciplinary roundtable sessions to provide expertise on medical issues
Maintains RN license
Conducts in-service training for claims staff on various medical conditions and treatment
Participates in industry meetings
What you will bring with you:
Current and valid Registered Nurse license in the state of Maine required
AA or Nursing Diploma required; BSN, BA or BS preferred
Minimum 3 years of clinical experience required
Strong knowledge of medical treatment protocols
Experience in utilization review/health care industry insurance preferred
Strong research, analytical, critical thinking, problem solving and decision-making skills
Ability and desire to work in a fast-paced, service-oriented environment
Excellent verbal communication skills, with the ability to be both pleasant and professional
Strong written communication 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 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 DRMS does business
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? Join our talent community 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 Globe's “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 California region: $89,800 – 134,700 annually
Northern California region: $96,000 – 144,000 annually
If you are a Minnesota, Colorado or Nevada resident, the salary range for this position is $81,300 – 122,000 annually
If you are an Illinois, Connecticut or Maryland resident, the salary range for this position is $85,200 – 127,800 annually
If you are Washington, Washington D.C., and Rhode Island resident, the salary range for this position is $89,800 – 134,700 annually
If you are a New York resident within the NYC Metro Area, the salary range for this position is $96,000 – 144,000 annually
If you are a New York resident outside the NYC Metro Area, the salary range for this position is $89,800 – 134,700 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
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 recruitingUS@sunlife.com to request an accommodation.
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.
Claims - Life & Disability
10/12/2024
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.
