Disability Adjudicator

1 month ago

Montreal, Canada Sun Life Full time

Job Description

:

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. 

What will you do?

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.

Required competencies: 

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

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 

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.

What’s in it for you?

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.

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.

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