Disability Claims Specialist, Bilingual-100% Remote

Medavie is a national health solutions partner that integrates benefits management, health management and health care delivery. Together, with our team of more than 7,700 professionals, we are committed to improving the wellbeing of Canadians.

As a not-for-profit organization, Medavie oversees Medavie Blue Cross, a premier all-in-one benefits carrier and public health program administrator, and Medavie Health Services, a national primary health care solutions organization and the largest contracted provider of emergency management services in Canada.

We are one of Canada's Most Admired Corporate Cultures, one of Canada’s Top 100 Employers and an Imagine Canada Caring Company.

We don’t have shareholders. Instead, we proudly invest in communities to help address some of Canada’s most pressing health care challenges.

As a Bilingual Disability Claims Specialist you will be working and collaborating with a team of talented professionals in a high-energy work environment to ensure service level standards are met by managing a block of short or long-term disability cases.

You will support our plan members through illness, recovery and return to work by providing them with disability benefits and proactive case management.

In this role you are responsible for the disability claim adjudication from the initial decision to building the right case management plan which includes but is not limited to: identifying the supports needed for each case, monitoring treatment and the achievement of the plan and working with the claimant, employer and providers involved in the case. Effective communication and organizational skills are an essential requirement for this role to help ensure all key milestones are met for each case. This position has a start date of and is available full time remote, hybrid or in-office based on your preference.

Key Responsibilities:

• Disability claim adjudication; reviewing eligibility of claimant, assessing total disability through the evaluation of medical information, telephone interviews etc.
• Build effective relationships with key stakeholders and claimants to support recovery and return to work.
• Effective and consistent use of an electronic case management system (Fineos).
• Active case management of files; provide ongoing and regular communication with all stakeholders of claim, assess use of claim tools (rehab, IME etc.), review and request ongoing medical as needed, provide ongoing assessment of key dates within the lifecycle of the claim (COD etc.) and ensuring case management plans are updated regularly.
• Render decisions on a timely basis and effectively communicate these decisions, at times potentially difficult decisions and manage escalations with employers and claimants.
• Accountability and responsibility to ensure that the management of required tasks within the assigned case load meets all service level standards.

Qualifications:

• Education: Post-secondary degree completed in Health Sciences (Kinesiology, Psychology, Rehabilitation, Social Work, Nursing, Clinical/Medical Office Administration) or a related field
• Work Experience: 1 to 3 years relevant experience. Background in a health-related field or case management would be an asset.

Other Qualifications & Assets:

• Excellent customer service and telephone skills with the ability to communicate complex and difficult information clearly with tact and sensitivity. At ease with both incoming and outgoing calls.
• Professional written and verbal communication skills to successfully partner and influence various stakeholders including the claimant, their treatment providers and physicians, the employer, group administrators, human resources, and lawyers.
• A general understanding of the health care and insurance fields, health related terminology, concepts of accommodation and return to work.
• Strong analytical skills, excellent problem-solving abilities and can work with minimum supervision.
• Strong organization and prioritization skills required to manage different type of tasks
• Experience and knowledge of managing files related to mental health.
• An understanding of contract wording and the ability to thoroughly review medical reports and other tools available (e.g., Independent Medical Exams, Function Capacity Exams, surveillance, medical consultant reviews) is an asset.

Computer Skills: Proficient keyboarding and technical aptitude in Microsoft Office. Experience working with an electronic case management system, such as Fineos is considered an asset.

Language: Bilingualism (English/French) is mandatory for this position.

To set you up for success, you will participate virtually in our 10 weeks paid training program, which will provide you with the necessary education, tools and resources required. While in training, you will be surrounded with colleagues who have your best interest at heart and will continue to support you as you gain your autonomy.

We offer a career path encouraging you to follow your passions, learn new skills and focus on growing your career with Medavie.

We are an Equal Opportunity Employer.

Medavie strives to foster a culture where everyone is enabled to achieve their full potential - a culture of diversity, equity and inclusion (DEI) where we live our values every day in the way we treat each other, our members and the communities we serve. Accessibility is a top priority.

For applicants with disabilities, we provide accommodations throughout the recruitment, selection and/or assessment process. If selected to participate in the recruitment, selection and/or assessment process, please inform Medavie Human Resources staff of the nature of any accommodation(s) that you may require in respect of any materials or processes used to ensure your equal participation. All personal information is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act.

We would like to thank all candidates for expressing interest. Please note only those selected for interviews will be contacted.

Job Segment: Rehabilitation, Healthcare Consultant, Claims, Counseling, Public Health, Healthcare, Insurance