Clinical Consultant — Disability Claims & Return-to-Work

Sun Life; South Portland (ME); On-site; USD 77,000 - 116,000; Full time

Job summary

Sun Life U.S. is seeking a Clinical Consultant to join our Clinical Services team. You will apply your clinical expertise to assess disability claims, provide insights on complex conditions, and support return-to-work planning using electronic medical records and communications.

This role emphasizes collaboration with claims professionals, education of stakeholders, and mentoring peers, with a focus on productive recovery timelines and quality decisions.

Qualifications

• RN licensure active and unrestricted
• BSN preferred
• CCM/CRRN certification or eligible

Responsibilities

• Evaluate medical documentation to assess disability claims and functional capabilities.
• Provide clinical insight on complex medical conditions, treatment plans, and recovery timelines.
• Collaborate with claims professionals to synthesize facts and support quality decisions.
• Educate and consult with physicians, vocational counselors, employers, and other stakeholders.
• Communicate medical determinations via phone and written reports.
• Support return-to-work planning through evaluation of restrictions, accommodations, and functional potential.
• Participate in peer collaboration and claims roundtables to share best practices.
• Mentor peers and educate internal teams on clinical topics and trends.

Skills

Interpersonal communication

Microsoft Office

Critical thinking

Time management

Judgment

Education

RN licensure (active, unrestricted)

BSN preferred

CCM/CRRN certification (or eligible)

Tools

Microsoft Office

Job description

Sun Life U.S. is seeking a Clinical Consultant to join our Clinical Services team. You will apply your clinical expertise to assess disability claims, provide insights on complex conditions, and support return-to-work planning using electronic medical records and communications.

This role emphasizes collaboration with claims professionals, education of stakeholders, and mentoring peers, with a focus on productive recovery timelines and quality decisions.