Claim advisor

2 weeks ago

Waterloo, 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.

Job Description:

Hybrid Role

The claims consultant will support the day to day accurate and timely handling of claims. This includes managing escalated client issues, subrogation and claims involving legal case management, ombudsmen claims and client impact situations. Assisting and monitoring questions from analysts/seniors to promote accurate and timely adjudication of claims and directing further investigations where necessary. Serve as the Claims Representative and key participant for install meetings, client requested tours and demonstrations, training roll outs and change initiatives. Also defined are competency levels for Teamwork, Customer Service, Giving and Receiving Feedback and Problem-solving and Decision-making.

What will you do:

  1. Understand systems, processes and other GB departments (Client Services, Group IT, etc.);
  2. Process and resolve escalated claims issues with Plan Sponsors, Plan Members, Business Development (Account Executives, Service Representatives), GBCCC and Member Impact Team (MIT);
  3. Field and manage questions from the analysts/seniors;
  4. Attend pre-install meetings and provide input from a claims adjudication perspective;
  5. Investigate and resolve Ombudsman’s cases, includes contacts with ombudsman’s office and client (both verbal and written communication required);
  6. Successfully support claims team through change initiatives;
  7. Lead and manage on-going training roll-outs;
  8. Participate in client tours and claims demonstrations;
  9. Serve as claims representative for Best Practice;
  10. Run focus reports and contribute to management of results to ensure service standards are met;
  11. Participate in departmental or GB projects as required;
  12. Maintain confidentiality and clean desk policy at all times;
  13. Participate in the establishment of individual performance plans;
  14. Attend training as required;
  15. Support on-going changes within the department and across business units.
    1. Diploma in Dental Hygiene (CEGEP/College or University);
    2. Experience working in a dental clinic;
    3. Strong knowledge of Group Insurance - Dental claims;
    4. As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only to answer calls from English and French-speaking clients across Canada or worldwide.

      Know how to navigate within and outside the department to resolve issues, conduct further investigation, identify inconsistencies in adjudication practices and identify training needs. p>

      Organizational Impact and Challenges:

      Know what Health and Dental Claims service standards are; ensure that claims/issues are managed or routed to the correct person/department to meet claim standards and satisfy clients' needs. Overtime may be required as dictated by business need. This role requires a set production and quality target range to be met daily. Good knowledge of the special policies.

      1. We’re proud to be recognized as a company with a 2023 Most Trusted Executive team by Great Place to Work Canada;
      2. Access to short-term assignments or ‘Gigs’ across the organization, to help you develop new skills and connections;
      3. 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;

        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. p>

        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.p>

        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.

        Job Category:

        Claims - Health & Dental

        Posting End Date:

        05/01/2025

        #

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