Disability Adjudicator

Sun Life • Montreal, QC

2d • CA$49,000 - CA$77,000 • Hybrid

About The Position

In Group Benefits, we serve more than 5 million Canadians - plan members and their dependents - through our more than 11,000 group benefit plans across the country. Our customers include employees, associations, affinity groups and creditors in virtually every industry in Canada, and we're proud to be their benefits provider. In Group Disability, we have a service and fiscal responsibility to our Plan Sponsors and Members. Our fiscal responsibility also extends to our company for both earnings and regulatory compliance. As well, we are all accountable for protecting and nurturing that reputation, one of our greatest assets. This includes both our externally and internally images as well as employee engagement. The Disability Adjudicator (DA) is a member of a team responsible for assessing and managing claims to resolution. This includes determining if plan members are entitled to receive benefit payments and developing appropriate actions plans for each claim. The actions of our Disability Case Managers (DCM) are aligned with our outcome focused case management methodology, our philosophy that work is healthy and our mission to assist Plan Sponsors in promoting the health and wellbeing of their Plan Members and providing them with financial peace of mind for their families. As Health Promoters Abilities Case apply a fair and consistent approach to claims management. Plan Members are engaged through open and respectful communication that considers the medical, social and personal dimensions of their claim. Disability Adjudicator also communicate regularly with our Plan Sponsors to ensure that they know what to expect in terms of recovery time lines for their members.

Requirements

• Bilingualism (French, English, both oral and written) is required to answer calls from English and French speaking clients across Canada and worldwide.
• Excellent communication skills
• Ability to handle calls of a sensitive or emotionally charged nature
• Well organized individual with strong analytical skills, excellent problem solving ability and can work with a minimum of supervision
• Must have a positive attitude, a commitment to quality service and be able to cope with the stress inherent in the nature of disability claims assessing, including high work volumes
• Good keyboarding skills and able to work in a PC environment
• Attention to detail is important due to the complexity of claims situations and contractual considerations
• Adaptability and flexibility are key to success in this role
• Strong team player, with a high interest in working in a cross-functional team environment
• Strong decision making
• Medical experience obtained through claims assessing, underwriting, nursing and health profession
• Knowledge of disability products and administration

Responsibilities

• Assess new short term disability (STD) claims for eligibility (coverage) and benefit entitlement by reviewing contractual, medical and occupational information
• Manage STD claims during acute period of absence. At this point, claims are transitioned to a Disability Case Managers.
• Ensure a smooth transition to the Disability Case Managers as required
• Develop and maintain appropriate action plans directed toward ethically influencing early and timely recovery, where appropriate.
• Communicate in a clear, effective and professional manner with plan members, plan sponsors, in order to obtain information and to convey claim status, action plans and decisions verbally and in writing, taking into account Privacy and Confidentiality and using language and tone that is geared to needs of audience.
• Communicates with lawyers, physicians and other departments through electronic mail, telephone, written correspondence and occasionally in person.
• Ensure work is completed accurately and in compliance with practice guidelines.
• Adhere to process audit control reports.
• Manage claims, using applicable caseload management tools, prioritizing work items in order to meet client service standards
• Takes responsibility for own personal job satisfaction and continuous development.
• Contribute to and foster a positive working environment. This ranges from identifying opportunities to improve processes and customer service through to providing support to team members, where possible, to ensure service standards are met.

Benefits

• Access to short-term assignments or ‘Gigs’ across the organization, to help you develop new skills and connections.
• A collaborative and interactive team environment
• Charitable giving through our You Give, We Give program lets you give back to your community – and in many cases, we’ll match your contributions.
• Care Days available for self-care or care of others (i.e., family or others you may support) and Sick Days to support your well-being.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed