Impress employers and recruiters.
Choose from hundreds of resume examples.

Impress employers and recruiters.
Choose from hundreds of resume examples.

Target Resume Now

About the Role

Oversee the full lifecycle of disability management claims, including complex files, from initial assessment to return to work, ensuring accurate documentation and client communication.

Responsibilities

• Manage all non-complex and complex claims, including psychological claims, multiple diagnoses, and co-morbid conditions.
• Conduct detailed functional interviews regarding activities of daily living (ADL) and provide tips to reduce barriers.
• Evaluate medical and workplace information to determine if key elements are present.
• Adjudicate claims in accordance with client and OSI policies with a high degree of excellence.
• Request clinical notes for claims requiring additional clarity.
• Enter detailed claim information, status, communications, and next steps into the Internal Claims Management System.
• Ensure a Care Management Action Plan is in place on all files, as required.
• Manage all claims with a return to work (RTW) focus for the shortest possible duration with a continuous improvement impact.
• Produce appropriate tools to communicate claim status to clients and claimants.
• Develop outcome-focused recovery and return to work plans, facilitating return to work as soon as possible.
• Determine when additional tools are to be used at the appropriate times (e.g., IME / FCE, refer to rehabilitation, medical consultant, pharmacogenetics, cognability, or workstation evaluations).
• Interact with key support service partners and health providers to enhance claim outcomes, facilitate treatment plans, and ensure optimal claimant treatment.
• Maintain awareness of claim status at all times, ensuring the Internal Claims Management System is fully updated.
• Communicate the employee’s functional capabilities to the employer to determine if modified duties can be provided in return to work planning.
• Facilitate return to work consistently with Transitional Return to Work Plans (TRTWP).
• Monitor progressive Transitional Return to Work Plans.
• Follow up on any missing claim actions or information.
• Complete file reviews with Team Lead on any claims over 30 days.
• Complete midpoint review with designated team members.
• Ensure reported comments are updated within the designated timeframe.
• Close claim in the Internal Claims Management System once claimant has returned to work.
• Act as the primary contact on assigned ad hoc claims.
• Record all billable and non-billable time in the Internal Claims Management System.
• Work with client(s) to understand workplace philosophy and job demands.
• Participate in monthly client calls and meetings as required.
• Update any monthly reports, as required.
• Work collaboratively as part of client(s) team both internally and externally.
• Coach and mentor other disability management staff by enhancing their knowledge and education levels.
• Provide support to other Recovery Facilitators and guidance on client(s) specifics and decision process and protocol.

Requirements

• Ability to plan, set objectives, and determine strategy to achieve them.
• Strong sense of urgency and organization/prioritization skills.
• Ability to identify problems and develop effective solutions quickly.
• Ability to work with great accuracy and attention to detail.
• Critical thinking skills, analytical reasoning, strong negotiation skills, and conflict resolution skills.
• Excellent customer service and communication skills.
• Ability to work within set procedures and policies to ensure privacy protocols and standard operating procedures are adhered to at all times.
• Ability to meet and exceed all Key Performance Metrics (KPM).
• Uphold a strict level of confidentiality.
• Excellent emotional intelligence and ability to appreciate different levels of experience providing appropriate support.
• Healthy view and understanding of mental health.

Skills

• Disability Management
• Claims Adjudication
• Return-To-Work Initiatives
• STD Claims Management
• LTD Claims Management
• Knowledge of short-term or long-term disability programs
• Knowledge of various treatment programs
• Knowledge of return to work planning and initiatives
• Understanding of medical terminology
• Understanding of common physical and mental health conditions
• Proficiency in Microsoft Office
• Ability to learn an internal database system
• Bilingual proficiency in French and English (asset)

Location

• Canada

Work Type

• Full-time

Experience Level

• Relevant experience in Disability Management / Claims Adjudication / Return-To-Work Initiatives / STD and LTD Claims Management

Education Level

• Registered professional designation / certification or working towards is an asset: (RN, RPN, Kin., RRP or other related healthcare background; Certified Disability Management Practitioner / Certified Return to Work Coordinator)

Salary/Compensations

• $60,000 - $67,000 annually

Benefits

• Extended health care and dental benefits
• A retirement savings plan with company contributions
• A suite of Health & Wellness offerings
• Mental Health programs and support for you and your family
• Assistance for the completion of industry designations

About the Company

• Organizational Solutions Inc. (OSI) is dedicated to providing exceptional disability management services tailored to the unique needs of organizations across Canada.

Equal Opportunity

• We are committed to providing an inclusive, accessible environment, where all employees and clients feel valued, respected, and supported.
• We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee has the opportunity to reach their potential.
• If you require an accommodation or an alternative format of any posting please reach out to careers@peoplecorporation.com.