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Disability Claims Adjudicator

4 months ago

Montréal QC, Canada Sun Life Financial Full time

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. Discover how you can make a difference in the lives of individuals, families and communities around the world.
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. 
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 
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.
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
Medical experience obtained through claims assessing, underwriting, nursing and health profession
Knowledge of disability products and administration 
Bilingualism (French, English, both oral and written) is required for the frequent interactions with English and French-speaking colleagues or internal partners across Canada and worldwide.
We’re proud to be recognized as a company with a 2023 Most Trusted Executive team by Great Place to Work Canada
Access to short-term assignments or ‘Gigs’ across the organization, to help you develop new skills and connections.
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.
In addition to Base Pay, eligible Sun Life employees participate in various incentive plans, payment under which is discretionary and subject to individual and company performance. Diversity and inclusion have always been at the core of our values at Sun Life. A diverse workforce with wide perspectives and creative ideas benefits our clients, the communities where we operate and all of us as colleagues. Persons with disabilities who need accommodation in the application process or those needing job postings in an alternative format may e-mail a request to thebrightside@sunlife.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.
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. Discover how you can make a difference in the lives of individuals, families and communities around the world.
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. 
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 
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.
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
Medical experience obtained through claims assessing, underwriting, nursing and health profession
Knowledge of disability products and administration 
Bilingualism (French, English, both oral and written) is required for the frequent interactions with English and French-speaking colleagues or internal partners across Canada and worldwide.
We’re proud to be recognized as a company with a 2023 Most Trusted Executive team by Great Place to Work Canada
Access to short-term assignments or ‘Gigs’ across the organization, to help you develop new skills and connections.
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.
In addition to Base Pay, eligible Sun Life employees participate in various incentive plans, payment under which is discretionary and subject to individual and company performance. Diversity and inclusion have always been at the core of our values at Sun Life. A diverse workforce with wide perspectives and creative ideas benefits our clients, the communities where we operate and all of us as colleagues. Persons with disabilities who need accommodation in the application process or those needing job postings in an alternative format may e-mail a request to thebrightside@sunlife.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.
Claims - Life & Disability Posting End Date:
Our supportive, flexible, and inclusive work environment is one where you – and your career – can thrive. Whatever your aspirations, collaborative leaders and colleagues are ready to help you learn, grow, and succeed.
Our purpose is to help Clients achieve lifetime financial security and live healthier lives. As part of Sun Life’s growing team, you have an impact on people in your community and around the world.
Use data to drive bold actions. Be agile and pivot as we test and learn. At Sun Life, we’re driving transformation, sustainability and innovation for our Clients, employees, partners, and communities.