Disability Claims Management Specialist Jobs

5+ years’ related experience in health claims management

Post secondary diploma in social work, medical science, risk management or communications.

Advanced understanding of claims management processes and objectives from inception to resolution cycles.

Assess claims for benefit entitlement by reviewing legislative, medical, functional, and occupational information.

Other duties as directed by the Senior Manager, Total Rewards.

Advanced knowledge of Microsoft Office applications including Word, Excel, Outlook.

Knowledge of Applied Systems EPIC Broker Management System an asset

Claims intake, reporting, file management

Work closely with account teams and clients to ensure exceptional client management.

Post secondary education, preferably in business administration or related field

4+ years of commercial insurance experience in a property and casualty or liability claims function

Experience in construction insurance an asset

Ability to provide an expeditious and delightful member experience

At least one year of experience providing customer service over the phone

French bilingual skills are a plus!

Review medical records to make claim outcome decisions against received invoice(s) as aligned with the Trupanion policy

Enter data from medical records into the database

Contact members regarding claim assessment and status (phone/email) as applicable

Ability to provide an expeditious and delightful member experience

At least one year of experience providing customer service over the phone

French bilingual skills are a plus!

Review medical records to make claim outcome decisions against received invoice(s) as aligned with the Trupanion policy

Enter data from medical records into the database

Contact members regarding claim assessment and status (phone/email) as applicable

Minimum of 3 years customer care experience (insurance, and health and dental benefits claims an asset)

Strong communication skills, both verbal and written

Claims adjudication and customer care experience.

Technical knowledge on application base system

A desire to provide exceptional customer service, and a valuable experience to clients.

Extended health care and dental benefits

Providing advice and guidance, including policy, procedure, and collective agreement interpretation, on disability management, return to work and accommodation

Researching, developing, and facilitating training sessions on disability management, return to work and accommodation

Collecting data, analyze, and report for our disability management and return to work program statistics

Coordinating the case management of WSIB, STD and LTD disability claims

Maintain confidential health files/case management files

Prepares communications (letters, etc.) to supervisors, employees and insurance providers regarding claims management

Knowledge of group benefits principles and experience with group benefits administration, minimum of 3 years, ideally in a large organization

Strong communication skills/telephone skills and experience including the ability to effectively manage conflicting or aggressive situations

Proactive management of disability claims including situations of a complex nature.

Experience with US benefits would be considered an asset

Experience in interpreting benefit plans and documents

Time management / ability to meet time sensitive deadlines

Bachelors degree +10 years experience in disability management and workers’ compensation

Knowledge of the workers’ compensation financial systems and regulations in force in provinces (Canada-wide)

Relevant experience in large size corporate environment with unionized workforce

Knowledge of SIGMA-RH an asset

Knowledge of SAP an asset

Bilingual French and English (written and oral)

Work Experience: 1 to 3 years relevant experience. Background in a health-related field or case management would be an asset.

Accountability and responsibility to ensure that the management of required tasks within the assigned case load meets all service level standards.

Effective and consistent use of an electronic case management system (Fineos).

Strong organization and prioritization skills required to manage different type of tasks

Strong analytical skills, excellent problem-solving abilities and can work with minimum supervision.

Experience and knowledge of managing files related to mental health.

Deadline driven Additional helpful attributes: Insurance claims knowledge or experience.

• Strong PC skills with experience using Microsoft Office 365, especially Outlook, Word and Excel

Supporting Disability Case Managers on a variety of tasks

Post-secondary education (would be an asset ).

Minimum 2 years previous experience in an administrative/clerical role (would be an asset).

Excellent communication skills (oral and written).

• Strong PC skills with experience using Microsoft Office 365, especially Outlook, Word and Excel

Deadline driven Additional helpful attributes: Insurance claims knowledge or experience.

CAN, Quebec - Full Time Remote

Administrative work, setting up long-term disability claims, 100% remote open to Ontario province and Nova Scotia province.

Prefer candidates that have analytical thinking, good attention to detail, and mathematical skills.

• Supporting Disability Case Managers on a variety of tasks

We're currently hiring - Apply Now! Remote work across all locations nationwide

Manage a large caseload of disability claims

Excellent communication skills in French & English (written and spoken)

Experience in effectively managing complex claims

Strong analytical and decision making skills and the ability to multitask and balance multiple goals and priorities

Excellent oral and written communication skills

Enrollment in specific designation and or certifications programs may be required for certain positions (e.g. Finance & Engineering).

Completed post-secondary, preferably in a related field OR a combination of equivalent professional experience and training

1 to 3 years of relevant functional experience

(If managing a team) One or more years’ experience managing people

One or more years of experience in a unionized environment an asset

Proficient computer skills and competent with Microsoft Office programs

Education and skills acquired at post-secondary level or equivalent education with over 4 years work experience

Strong organization and time management skills

Provide office measurement support to the Regional Manager in areas of work volumes, productivity and financial management

Manage the overall financial accountability for all disability benefit calculations, payments, and claim reserve calculations performed by the team

Hiring and performance management of direct reports including coaching and staff development

Collection and analysis of data required to ensure effective operational management of the office

Must have knowledge of claims and disability management;

Conducts in-house training for all management and administrative staff as it relates to the Integrated Attendance Management Policy;

Recommend expenditures on LTD claimants for therapies such as psychologists, treatment facilities or educational plans.

Must have strong communication skills, both written and verbal and have excellent organizational and analytical skills;

Previous working experience with PeopleSoft HRMS and the Microsoft suite of products would be considered an asset;

Knowledge of medical terminology would be considered an asset;

Extensive Disability Management knowledge including understanding the adjudication process and contractual requirements

Excellent people skills in order to manage relationships with clients and benefit providers

Support Claims Management Specialist with escalations of client challenges with a focus on resolution and ongoing improvement of the client experience

Create claims history and trending reports to identify opportunities for wellness initiatives, claims reduction, or absenteeism management

Design and provide engaging training, ongoing mentorship, and development opportunities to Claims Management Specialist

Measure Claims Management Specialist progress and determine appropriate training solutions

Education or work experience in an audit/quality/fraud discipline considered an asset

Post-secondary degree/diploma or equivalent work experience

Experience within a paramedical or other clinic setting considered an asset

Excellent communication skills, both written and oral

Ability to manage multiple demands with tight deadlines is necessary.

Understanding of Health Claims processes and business knowledge would be an asset.

Responsible for assisting in the timely management of Creditor Disability Claims

Proven exceptional organizational skills with the ability to manage several tasks at the same time

Responsible for accurate and timely benefit payment calculations

Responsible for accurate and timely data entry

Proven exceptional communication (written/verbal) skills

Post-secondary education in health or business administration

Sound knowledge of contemporary and best practice approaches in disability and absence management.

Contribute to the development of a provincial strategy for disability management programs for the BC Health Authorities and Providence Health Care

Contributes to the development of Health Authorities' strategy and goals for the OSH Council regarding designated disability management programs.

Participates in HEABC led Provincial Working Group providing leadership and expertise in disability management at the provincial level.

Leader for Provincial Disability Management Services

Working knowledge of applicable regulations, legislation, policies and procedures.

Knowledge of claims and case management human resource practices and relevant collective agreements.

Performs a variety of administrative duties such as preparing correspondence, reports, policies/procedures, minutes, charts and graphs using various software programs.

Initiates and maintains efficient manual and electronic filing systems to fulfill required needs.

Demonstrated ability to effectively deal with staff, third party providers and the general public

Ability to type at 65 wpm

Ability to operate related equipment including applicable software applications