Sr. Consultant, Appeals

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.

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 opportunity:

In this role, you will administer appeals and/or complaints for various Group Benefit plans including STD, LTD, Life, LWOP and AD&D, paying strict attention to ERISA timeframes and other regulatory requirements.

How you will contribute:

• Upon receipt of all assigned appeals or complaints, you will acknowledge receipt, conduct a full and fair review of the claim file, and develop an action plan for the investigation, analysis and resolution of the pending matter.

• You will identify all issues that are the subject of the appeal or complaint and identify (b) any additional information that is needed, and/or (c) any additional resources that may be required in order to complete a full and fair review.

• You will obtain and help to coordinate the use of clinical, vocational and investigative resources as needed.

• For those appeals and/or complaints that you have administered which end up in litigation, you will serve as the person most knowledgeable and as point of contact and assistance for SL attorneys assigned to the management of the litigation.

• Upon completion of all assigned matters, you will provide appropriate feedback to case managers and claims management whenever possible.

• You will complete special projects and Brighter Way CIs, as needed, on matters including but not limited to training, process enhancements, policy interpretation, etc.

What you will bring with you:

• Ability to work with a diverse group of people

• Bachelor's Degree (preferred)

• 5+ years of experience in disability and/or life insurance claims administration or appeals; LTD Claims Experience Preferred

• Strong research, communication, analytical, critical thinking, problem solving and decision-making skills.

• Strong interpersonal and customer service skills, including the ability to successfully resolve conflict when it arises.

• Ability to appropriately identify and assess legal, reputational and other risks.

• Detail oriented and organized, with good time management skills and the ability to prioritize and multi-task.

• Excellent communication and customer service skills.

• Detailed knowledge of disability and life insurance contract principles, including but not limited to Eligibility, Pre-Existing Conditions, Disability, Proof of Claim, etc.

• In-depth knowledge of claims practices for STD, LTD, Life and LWOP, as well as the ability to learn other product types.

• Considerable knowledge of insurance related laws and regulations including Social Security law, HIPAA, Workers' Compensation, ERISA and Unfair Claims Practices.

• Ability and desire to work in a fast-paced, service-oriented environment.

• Ability to work well both independently, and in a collaborative environment.

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: $75,800 - $113,700 annually

• Central California region: $79,900 - $119,900 annually

• Northern California region: $85,400 - $128,100 annually

If you are a Minnesota, Colorado or Nevada resident, the salary range for this position is $72,300 - $108,500 annually.

If you are a Connecticut or Maryland resident, the salary range for this position is $75,800 - $113,700 annually

If you are Washington or Rhode Island resident, the salary range for this position is $79,900 - $119,900 annually

If you are a New York resident, the salary range for this position is $85,400 - $128,100 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.

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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.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

Job Category:

Claims - Life & Disability

Posting End Date:

29/08/2024

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.