Claims Adjuster I assisting customers who have suffered minor injuries from motor vehicle accidents. Ensuring timely investigation and adjudication of medical claims.
About the role
- Bilingual Disability Claims Specialist at Medavie supporting members through illness and recovery. Responsible for disability claim adjudication, case management, and building stakeholder relationships.
Responsibilities
- Responsible for the disability claim adjudication from the initial decision to building the right case management plan including 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.
- Active case management of files, providing regular communication with all stakeholders and assessing the use of claims tools (rehab etc.) and requesting ongoing medical as needed.
- Provide assessment of key dates within the lifecycle of the claim and ensure case management plans are updated regularly.
- Ensure that required tasks within the assigned case load meet service level standards.
- Render timely and potentially difficult decisions and effectively communicate these decisions, while managing escalations with employers and claimants.
- Build effective relationships with key stakeholders (the claimants, the treatment providers and physicians, the employers, group administrators, human resources, and lawyers) to support recovery and return to work.
- Ensure effective and consistent use of our electronic case management system.
Requirements
- Education: University degree or a completed college diploma related to occupational health, disability management, kinesiology, Education, Human Resources, Legal Study areas are assets but are not limited.
- Work Experience: Candidates with a combination of education and/or experience with well-developed analytical, decision-making and problem-solving skills.
- Experience related to disability claims management, insurance benefits, adult education, kinesiology or other health-related industries or new graduates with a Degree or Diploma in Disability Management, Kinesiology, Rehabilitation Medicine or other health-sciences.
- Experience in a professional setting where you have the demonstrated ability to make critical decisions, solve problems and both work as a team and autonomously to pivot quickly and help clients navigate complex situations.
- Experience reviewing contracts, medical files and reports therefore experience in assessing different information sources to inform decisions and to advise customers is a definite asset.
- Proficiency working with Microsoft Office applications (Word, Excel and Outlook)
Benefits
- Comprehensive health, vision and dental plan that is 100% employer paid effective on your first day
- 100% employer-matched Defined Contribution Pension Plan
- Annual Incentive Bonus which recognizes your contribution to our success
- Paid vacation and additional Vacation Purchase Program
- Wellness benefits, health resources and fitness center discounts
- Flexible work arrangements and emphasis on work-life balance
- Participate virtually in our 15-week paid training program to set you up for success with necessary education, tools and resources
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