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Absence & Disability Consultant

2 months ago

Wellesley Hills, United States Sun Life Full time

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.

**Location**: We support US flexible working arrangements in the contiguous 48 states.

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 Absence & STD Consultant works with employers, employees, and health care providers to administer an integrated Family and Medical Leave Act (FMLA) rights and responsibilities and Short-Term Disability claim. Provides advice and counsel regarding leave administration and effectively coordinates all cases/claims in compliance with the FMLA and all related employment laws. Responsible for the professional management of both routine and complex claims for Group Short Term Disability while working both independently and in a team to ensure superior service to policyholders and claimants. Reviews claims and makes final determination for admittance or denial. Approves payment of claims and Company liability within established limits.

**How you will contribute**:

- Interprets and administers leave programs and policies in accordance with the applicable federal and state employment laws (FMLA, ADA, USERRA, Pregnancy Discrimination Act, etc.).
- Facilitation and engagement in interactive dialogue with employees, medical professionals, supervisors, and HR business partners to assist employees.
- Documentation of the request for absence including detailed points of contact and actions taken to coordinate the accommodation request.
- Reviews claim payments within established limits and/or reviews recommendations made by medical resources to determine proper disposition of claims.
- Sets claim action plan to ensure that determinations are adjudicated in a timely, accurate, and efficient manner.
- Interprets contracts and ensures consistent, fair claims practices and adherence to appropriate laws, regulations, and procedures.
- Obtains backup documentation, as necessary, to substantiate claims or to provide service by communicating via telephone with agents, employers (policyholders), claimants, hospitals, physicians, attorneys, and other resources.
- May handle other related duties such as providing technical assistance to other Claims staff or assisting in special projects
- Protect and maintain personal health information with a high level of confidentiality abiding by Sun Life procedures and by HIPPA rules and regulations.

**What you will bring with you**:

- Ability to work with a diverse range of people.
- 1+ years of customer, absence, and claims services experience
- Communicating effectively and professionally with a wide variety of both internal and external Sun Life business partners, peers, and resources.
- Effective ability to use legal resources and demonstrate a proven ability to comprehend and interpret legal and medical terminology to make final decisions to approve or further investigate claims.
- Attention to detail with documentation, reporting and communication.
- Demonstration of strong mathematical skills for calculations and adjustment of claim payments.
- Facilitation skills in a variety of circumstances and with a wide variety of input. Ability to influence and teach.
- Self-directed with an ability to work independently and make independent judgments and decisions.
- Strong organizational skills, including the ability to prioritize work and multi-task
- Strong research, analytical, critical thinking, problem solving skills and decision-making skills.
- Ability and desire to work in a fast-paced, service-oriented environment.
- Excellent verbal communication skills, with the ability to be both pleasant and professional.
- Ability to work professionally and effectively with co-workers, clients, claimants, vendors, and others with whom Sun Life does business.
- Strong organizational skills, including the ability to prioritize work and multi-task.
- Strong verbal and written communication skills.
- Strong interpersonal and customer service skills.
- Ability to initiate and prioritize regular work duties and projects.
- Detail oriented, organized, the ability to multi-task, and strong time management skills.

**Life