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Senior Consultant I, LTD Claims Investigation Services

75% Flex
FULLY FLEXIBLE
Remote: 
Full Remote
Contract: 
Salary: 
72 - 128K yearly
Experience: 
Expert & Leadership (>10 years)
Work from: 

Offer summary

Qualifications:

Must have 10+ years claims management experience, Working knowledge of investigative tools.

Key responsabilities:

  • Assist in investigations and case management strategies
  • Handle multiple priorities, audit files, coordinate checks
DentaQuest logo
DentaQuest Large https://www.dentaquest.com/
1001 - 5000 Employees
See more DentaQuest offers

Job description

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Your missions

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.

Job Description:

As a resource to Case Managers, the CIS Team assists in obtaining information that may be relevant to the claims investigation and adjudication process.  Senior Consultants (CIS) assist Case Managers to complete investigations that reflect strong claims fundamentals.  An ideal candidate has 10+ years of claims management experience, and is able to identify Optimal Next Step activities that are likely to add relevant information to the Disability assessment.  A working knowledge of investigative tools and understanding their potential impact to risk management is key.  

If you have the desire to assist in technology driven public information searches and activities investigations, to liaison with Compliance when misrepresentation is expected, and to collaborate with claims colleagues regarding case management strategies - this could be the role for you.  We are looking for a candidate with a high level of energy who will leverage their claims management experience and analytical skills in a collaborative team environment. 

What you will do:

  • Audit files with the ability to handle multiple priorities simultaneously to prevent, detect and mitigate suspicious activity.
  • Triage files with case managers, clinical and vocational staff.
  • Coordinate background checks and surveillance with vendors.
  • Manage and prioritize a group of claims on an ongoing basis while maintaining appropriate documentation.
  • Obtain all pertinent and necessary information to evaluate claim credibility.
  • Use investigative tools, may testify in court cases and provide depositions related to claim disputes based on technical expertise

What you need to succeed:

  • Excellent written and verbal communication skills with client service orientation
  • Must be able to work independently and a team environment
  • Ability to conduct detailed claimant interviews
  • Solid critical thinking skills as well as the ability to negotiate with people
  • Ability to work with a diverse range of people

Required education and skills:

  • Demonstrated expert analytical skills with the ability to think creatively and address the strengths and weaknesses of a claim and the fine distinctions in contract language
  • 3+years’ experience managing Group Disability Claims, strongly preferred.

What is in it for you?

  • Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
  • Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account
  • A flexible work environment with a friendly, caring, collaborative and inclusive culture
  • Great Place to Work® Certified in Canada and the U.S.
  • Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running


   
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.  
   
If you are a California resident, the salary range for this position is:  
-
Southern California region: $75,800 - $113,700 annually 
-
Central California region: $79,900 - $119,900 annually 
-
Northern California region: $85,400 - $128,100 annually 
  
If you are a Colorado or Nevada resident, the salary range for this position is $72,300 - $108,500 annually 
 
If you are a Connecticut or Maryland resident, the salary range for this position $75,800 - $113,700  annually 
 
If you are Washington or Rhode Island resident, the salary range for this position is $79,900 - $119,900  annually 
  
If you are a New York resident, the salary range for this position is $85,400 - $128,100  annually 
   
We consider various factors in determining actual pay including your skills, qualifications, and experience.  In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.  
  
Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.  
  
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.   
  
#LI-remote    

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email recruitingUS@sunlife.com to request an accommodation.

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.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

Job Category:

Claims - Life & Disability

Posting End Date:

05/07/2024

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Required profile

Experience

Level of experience: Expert & Leadership (>10 years)
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Soft Skills

  • Analytical Thinking
  • Interview Skills
  • Interpersonal Skills
  • Teamwork
  • Critical Thinking
  • Negotiation Techniques
  • Service Orientation

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