Job Description

You are as unique as your background, experience and point of view. Here, youxe2x80x99ll 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.:Hybrid RoleThe 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:Understand systems, processes and other GB departments (Client Services, Group IT, etc.);Process and resolve escalated claims issues with Plan Sponsors, Plan Members, Business Development (Account Executives, Service Representatives), GBCCC and Member Impact Team(MIT). Understand systems, processes and other GB departments (Client Services, Group IT, etc.);Field and manage questions from the analysts/seniorsAttend pre-install meetings and provide input from a claims adjudication perspectiveInvestigate and resolve Ombudsmanxe2x80x99s cases, includes contacts with ombudsmanxe2x80x99s office and client (both verbal and written communication required);Successfully support claims team through change initiativesLead and manage on-going training roll-outsParticipate in client tours and claims demonstrationsServe as claims representative for Best PracticeRun focus reports and contribute to management of results to ensure service standards are metParticipate in departmental or GB projects as requiredMaintain confidentiality and clean desk policy at all times;Understand and adhere to Sun Life Financial Code of Business Conduct;Participate in the establishment of individual performance plans;Attend training as required;Contribute to the overall success of ACT; keep Customer satisfaction (our direct influence on the Customer Loyalty Index and Member Loyalty Index) in mind and remain conscious of our departmental commitments;Support on-going changes within the department and across business units.What do you need to succeed:xe2x80x8bDiploma in Dental Hygiene (CEGEP/College or University)Experience working in a dental clinicStrong knowledge of Group Insurance - Dental claimsCustomer service orientedExcellent communication skills both verbal and writtenExcellent problem solving skillsSelf motivatedTeam oriented Ability to work in a changing environmentStrong decision making skillsOpen to receiving and giving feedbackAs 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
xe2x80x8bDecision-making:Know how to navigate within and outside the department to resolve issues, conduct further investigation, identify inconsistencies in adjudication practices and identify training needs.Ensure that reference material inconsistencies are escalated to the appropriate area so that all documents are properly aligned.
xe2x80x8bxe2x80x8bOrganizational 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 need.Notes/Unique Requirements:Overtime may be required as dictated by business needThis role requires a set production and quality target range to be met dailyGood knowledge of the special policies.Whatxe2x80x99s in it for you?Wexe2x80x99re proud to be recognized as a company with a 2023 Most Trusted Executive team by Great Place to Workxc2xae CanadaAccess to short-term assignments or xe2x80x98Gigsxe2x80x99 across the organization, to help you develop new skills and connections.A collaborative and interactive team environmentCharitable giving through our You Give, We Give program lets you give back to your community xe2x80x93 and in many cases, wexe2x80x99ll 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.When a new position becomes available which matches your background and experience, the base pay range will be disclosed and correspond to the opportunity Sun Life will consider you for.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. Certain sales focused roles have sales incentive plans based on individual or group sales results.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. We welcome applications from qualified individuals from all backgrounds.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 .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.We thank all applicants for showing an interest in this position. Only those selected for an interview will be contacted.Job Category: Claims - Health & DentalPosting End Date: 05/01/2025

Sun Life Financial