Senior Consultant II, Integrated Absence & STD

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:

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 Consultant II, Integrated Absence & STD serves as a technical resource to the team, including managing workflow, review of claim decisions, performing quality assurance reviews, claim assignment, resolving complex issues/conflicts, addressing employer questions and concerns, handling escalated calls, as well as mentoring employees. Also responsible to manage a reduced case load of (25%-30% of a caseload) of claims.

How you will contribute:

Claim Management

• Reviews and investigates STD, FMLA, PFML, ADA and other state, local, and company leave claims thoroughly by using telephone and written contact with the applicable parties to gather pertinent data to analyze the claim(s)
• Adjudicates claims accurately and fairly in accordance with federal, state, local, and ERISA regulations, the STD contract, appropriate claim policies and procedures, meeting productivity and quality standards
• Utilizes appropriate medical, vocational and risk resources
• Conducts in-depth pre-existing condition or contestable investigations
• Calculates benefit payments and related offsets, taxes, etc.
• Coordinates return to work, including coordination of placement of needed accommodations, working closely with Vocational Consultants
• Assists with heavy claim loads
  
  

Technical Expertise and Team Support

• Serves as a technical resource to the team
• Manage workflow of the team through analyzing individual claim loads and distributing new claims
• Share claim review sign-off responsibilities with manager
• Handles escalated claimant and employer emails and calls
• Performs quality assurance reviews
• Identifies and communicates developmental areas which need improvement
• Provides developmental feedback to team members on case level decisions within the context of a mentoring relationship
• Is considered an expert within the department. Takes the initiative to problem, support departmental development, special projects, and programs
• Recognizes the value of idea sharing and presents to peers.
• Assist in the design and delivery of mentoring and training programs
• Review and sign off on new employee action assessments
• Assists with segment reviews and audits
  
  

Other Responsibilities

• Coordinate coverage for manager in their absence
• Runs point with employer touchpoint calls as needed to review claims
• Supports technological initiatives for the enhancement and efficiency of the claims management process
• Supports and executes claim management initiatives
• Participates in the development of internal policies and procedures
• Participates in industry or client meetings
• Obtain/maintain TPA licensing and required credit hours
• Participate in in-service and training opportunities as required
• Assists with heavy claim loads, segment reviews, and audits
  
  

What you will bring with you:

• Ability to work with a diverse range of people
• Minimum 5 years previous related work experience including STD and FMLA product line experience
• 1 year experience within FullscopeRMS STD or Integrated Absence & STD claim department preferred
• Experience administering PFML, ADA, or other leave programs
• Attains and maintains appropriate TPA licenses in accordance with the Claims Licensing Policy
• Proven ability to train and mentor new employees
• Demonstrated ability and willingness to give candid and meaningful feedback
• Proven history of excellent risk management
• Effectively manages and resolves escalated calls and complex customer service issues
• Expert technical ability in interpreting and communicating disability contract language and FMLA and state or local leave regulations
• Exposure to various issues within STD, FMLA and/or PFL with demonstrated experience in generating and selecting solutions to resolve those issues
• Solid analytical, critical thinking, problem solving and decision-making skills
• Ability to interpret and communicate STD and FMLA/PFL/ADA and other leave regulation language
• Exceptional understanding of highly complex claim practices
• Committed to lifelong learning and personal professional development
• Excellent communication skills
• Solid mathematical skills
• Strong interpersonal and customer service skills
• Strong computer skills, proficient in a PC environment and MS Word, Excel, and email systems
  
  

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: $79,900 - $119,900 annually
• Central California region: $84,200 - $126,300 annually
• Northern California region: $90,100 - $135,200 annually
  
  

If you are a Colorado or Nevada resident, the salary range for this position is $76,200 - $114,300 annually

If you are a Connecticut or Maryland resident, the salary range for this position is $79,900 - $119,900 annually

If you are Washington or Rhode Island resident, the salary range for this position is $84,200 - $126,300 annually

If you are a New York resident, the salary range for this position is $90,100 - $135,200 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.

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 [email protected] 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:

Absence / Leave Management

Posting End Date:

30/06/2024

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.