About the role

Bilingual Disability Case Manager adjudicating short- and long-term disability claims for Canadian benefits administrator Manion. Assessing medical documentation, managing claimants, and resolving complaints.

Responsibilities

Process and adjudicate short- and long-term disability claims
Establish eligibility and review medical documentation to determine whether Total Disability criteria are met
Calculate earnings and benefit levels accurately
Conduct telephone interviews with claimants
Request appropriate medical documentation, including MC, MRT, IME, FCE, and Rehab documentation
Maintain accurate, detailed claims documentation and confidentiality of client, corporate, and medical records
Adhere to department turnaround times for claims adjudication
Communicate verbally and in writing with empathy and clarity
Explain coverage, client responsibilities, and next steps
Resolve client complaints and build strong working relationships
Establish relationships with unions and employers
Ensure privacy regulations are followed and only allowable information is released
Review claims holistically to determine workable solutions within policy
Identify inefficient processes and present workable solutions to management
Collaborate with team members and clients to meet department turnaround standards
Report directly to the Manager, Disability Department

Post-secondary diploma or degree in Health Sciences or a related discipline
Insurance/industry-related designations considered an asset (CEBS, LOMA, ALHC, CDMP, CRTWC)
4 years of disability industry or case management related work experience
Ability to process and adjudicate short- and long-term disability claims
Ability to assess medical documentation and essential job duties
Ability to conduct telephone interviews and request appropriate medical documentation
Ability to maintain accurate, detailed claims documentation and confidentiality
Ability to adhere to department turnaround times
Ability to explain coverage details, client responsibilities, and next steps clearly
Ability to resolve client complaints and build relationships with unions and employers
Knowledge of privacy regulations
Ability to review claims holistically and determine solutions within policy parameters