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