Clinical Consultant

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.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

Job Description:

We are proud to be a hybrid organization that offers our employees the flexibility to work from both the office and virtually based on the needs of the business, our Clients and you. This means that if you are within a reasonable commuting distance, sometimes you will work in the office and sometimes you will work at home, with the frequency of each defined through discussion between you and your manager. Please note that whether you live in a reasonable commuting distance to an office will be determined by Sun Life in its sole discretion. If you do not live within a reasonable commuting distance, there may be times that you will need to come into a Sun Life office to participate in events, to collaborate or for business continuity purposes. In these instances, you will work with your manager to coordinate travel details. ​

The opportunity:  

 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 in regard to 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