Clinical Consultant: Disability Claims & RTW

Sun Life; Wellesley (MA); Hybrid; USD 77,000 - 116,000; Full time

Benefits offered by this job

Generous vacation & sick time

Paid family leave

Parental leave

Adoption leave

Medical coverage

Life and AD&D insurance

Disability programs

Sabbatical program

Job summary

Sun Life embraces a hybrid work model combining in-office collaboration with virtual work. The Clinical Consultant role sits within our Clinical Services team, focusing on returning clients to productive levels without direct hands-on care.

Work is conducted through electronic medical records and phone/fax communications. You will evaluate medical documentation, provide clinical insight, and collaborate with claims professionals to inform decisions.

Qualifications

• RN licensure active and unrestricted.
• BSN preferred.
• CCM/CRRN certification encouraged 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 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

Communication skills

MS Office proficiency

Critical thinking

Time management

Judgment

Education

RN licensure

BSN preferred

Tools

Outlook

Word

Excel

Clinical systems

Job description

Sun Life embraces a hybrid work model combining in-office collaboration with virtual work. The Clinical Consultant role sits within our Clinical Services team, focusing on returning clients to productive levels without direct hands-on care.

Work is conducted through electronic medical records and phone/fax communications. You will evaluate medical documentation, provide clinical insight, and collaborate with claims professionals to inform decisions.