Patient Scheduler coordinating appointments, insurance verification, and patient access for IKS Health’s healthcare provider solutions. Remote bilingual role supporting efficient scheduling and revenue cycle operations.
About the role
- Bilingual Disability Claims Consultant assessing disputed disability claims for Sun Life’s insurance clients. Supporting appeals, case decisions, client communication and national process improvements.
Responsibilities
- Assess and manage disputed disability claims referred to the Appeal team through Sun Life’s disability appeal process
- Assess disputed disability claims in accordance with claims practices and procedures within organizational service standards
- Take action on appeals where information gaps are identified by obtaining outstanding information and/or requesting appropriate third party assessments
- Support Disability Case Managers on optimal claims decisions, considering contract, medical, functional and vocational components
- Work with Team Managers to identify and close gaps in case management and decision deficiencies through coaching
- Evaluate and weigh the totality of information and the impact decisions have on clients
- Communicate with clients respectfully and empathetically throughout the appeal process and deliver final appeal decisions sensitively
- Report on emerging trends for national action and leverage learnings where suitable
- Identify opportunities to continuously improve processes to meet service excellence, quality and financial commitments
Requirements
- Exceptional decision making and case management skills focused on positive outcomes for plan sponsor, plan member and Sun Life Financial
- Critical thinking and stellar client service skills
- Strong analytical, organizational and problem solving skills
- Solid knowledge of group disability insurance policy and coverage concepts
- Excellent listening skills and capacity for empathy
- Exceptional verbal and written communication skills
- Ability to present case reviews in group settings and collaborate in group discussions
- Ability to evaluate and identify key information relevant to each case to present to the Appeal committee
- Ability to deliver constructive decisions and feedback in a tactful and sensitive manner
- Adaptability, flexibility and strong decision making skills
- Bilingualism (French, English, both oral and written) is required for Quebec
- A bachelor's degree or equivalent business experience
- 3-5 years Disability Claims experience
Benefits
- A friendly, collaborative and inclusive culture
- A collaborative and interactive team environment
- Working together, sharing common values and encouraging growth & achievement
- Hybrid work arrangement with choice and flexibility to work from the office and virtually based on business, client and employee needs
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