Clinical Consultant — Disability Claims & RTW

Sun Life; Portland (ME); Hybrid; USD 77,000 - 116,000; Full time

Job summary

Sun Life U.S. is a leading provider of employee and government benefits with a hybrid work model.

As a Clinical Consultant in our Clinical Services team, you will review medical documentation to support disability claims, provide clinical insights, and coordinate with claims professionals to drive return‑to‑work decisions. You will mentor peers, educate internal teams on trends, and interact with physicians and employers.

Qualifications

• RN licensure required and active
• BSN preferred but not required
• CCM or CRRN certifications encouraged
• 3+ years of clinical experience with adult working-age population
• Experience in rehabilitation, occupational health, case/care management, or disability insurance a plus
• Strong communication across multiple audiences
• Proficiency with Microsoft Office and clinical systems
• Self-motivated with strong time management and judgment skills

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 and accommodations.
• Participate in peer collaboration and claims roundtables to share best practices.
• Mentor peers and educate internal teams on clinical topics and trends.

Skills

RN licensure

MS Office proficiency

Strong communication

Critical thinking

Time management

Judgment skills

Self-motivated

Adaptability

Education

RN licensure required

BSN preferred

CCM certification

CRRN certification

Tools

Outlook

Word

Excel

Job description

Sun Life U.S. is a leading provider of employee and government benefits with a hybrid work model.

As a Clinical Consultant in our Clinical Services team, you will review medical documentation to support disability claims, provide clinical insights, and coordinate with claims professionals to drive return‑to‑work decisions. You will mentor peers, educate internal teams on trends, and interact with physicians and employers.