Senior Consultant I, LTD Claims Investigation Services

About the role

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. At Sun Life, we're driven by our Purpose: helping our Clients achieve lifetime financial security and live healthier lives. Our values shape how we work: caring, authentic, bold, inspiring, and impactful.

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week.

Responsibilities

• Assist in obtaining information relevant to the claims investigation and adjudication process.
• Audit files with the ability to handle multiple priorities simultaneously to prevent, detect and mitigate suspicious activity.
• Triage files with case managers, clinical and vocational staff.
• Coordinate background checks and surveillance with vendors.
• Manage and prioritize a group of claims on an ongoing basis while maintaining appropriate documentation.
• Obtain all pertinent and necessary information to evaluate claim credibility.
• Use investigative tools; may testify in court cases and provide depositions related to claim disputes based on technical expertise.

Requirements

• 3+ years’ experience managing Group Disability Claims, strongly preferred.
• Demonstrated expert analytical skills with the ability to think creatively and address the strengths and weaknesses of a claim and the fine distinctions in contract language.
• Excellent written and verbal communication skills with client service orientation.
• Ability to work independently and in a team environment.
• Ability to conduct detailed claimant interviews.
• Solid critical thinking skills as well as the ability to negotiate with people.
• Ability to work with a diverse range of people.

Pay

Salary: $72,500 – $108,800 (base salary determined based on unique skills, qualifications, experience, education, and geographic location; eligible for a discretionary annual incentive award).

Benefits

• 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 and an employer-funded retirement account.