Specialist, Claims

Vaughan (Cityview Blvd. or Hamilton (John St.): Remote/In-office)

Reports to:

Manager, People Relations & Claims Abilities Management

Business Unit:

People & Safety

Division:

People & Safety

35

Rate of Pay:

Commensurate with range and candidate’s experience

Number of Openings:

1

Union:

No

Open:

May 2, 2024

Close:

May 16, 2024

Alectra is committed to putting our people first in providing a positive employee experience and a safe work environment. Our Hybrid Workplace policy allows for an effective balance for employees with the opportunity to work in a hybrid environment; a combination of Remote / In-office work based on operational requirements.

Position Purpose:

The Specialist, Claims and Abilities is responsible for the effective day-to-day administration, response, and claims management of all occupational and non-occupational illness and injuries.This role leads the accommodation process through planning, implementing and coordinating early and safe return to work programs with applicable internal and external stakeholders, to enhance and support the Company’s Health and Safety culture.

Key Responsibilities/Accountabilities:

• Manages and leads the accommodation process through planning, implementing, and coordinating early and safe return to work programs with internal customers - employees, People Leaders, People Services, unions, (if requested), and external customers – WSIB, long term disability provider, Company doctor, and third-party medical vendors.
• Responsible for communication, administration and maintenance of concise records, and confidentiality maintaining and regularly reporting all-inclusive case activity and return to work statistics.
• Provides proactive management to employees of occupational and non-occupation claims, by identifying return to work factors, removing obstacles, and leveraging opportunities to facilitate early and safe return to work.
• Develops and monitors Early and Safe Return to Work programs in accordance with medical reports (CAE – Cognitive Abilities Evaluation, FAF - Functional Abilities Form, MNR – Medical Narrative Request), collective agreements and provincial legislation.
• Monitors progression throughout the program and obtains additional medical documentation when required.Establishes regular touchpoints with employees and People Leaders on suitable work, restrictions, upcoming medical appointments, process, return to work plans and timeframe in the program.
• Prepares reports, letters, and correspondence for non-occupational claims management (preambles for MNR, MNR, doctor to doctor consultation, Independent Medical Evaluation (IME), consent and authorization forms) for illness, injury and working from home accommodations.
• Prepares WSIB Form 7 for occupational illness and injury.Prepares reports, letters and correspondence to WSIB including issues/objections, Second Injury Enhancement Fund (SIEF) requests, and late filing penalties challenges.Send regular updates on employee progress, including updated FAFs and Form 42 – Employer Progress Report.
• Prepares Long Term Disability (LTD) package in the case of a non-occupational illness or injury, including completion of employer statement.Submit monthly RehabilitationEarnings Statement to LTD Provider when employee returns on a graduated RTW Program.Complete status update monthly report to LTD provider regarding employees off on LTD. Provide regular updates to LTD provider regarding approved claims, claim closures, return to work, and life insurance waivers. Communicates with Canada Life as required to ensure timely and accurate submission of waiver of life insurance premium claims.
• Acts as the point of contact to respond to claim inquiries, both internally and externally, from all levels including management, employees, People Services, union representatives, Payroll, Health and Safety, WSIB , insurance companies, company doctor and 3rd party medical vendors.
• Tracks and manages all claims related data including absence/accommodation history, lost time, return to work dates, review dates, legacy sick bank, LTD monthly report, etc. Develop & maintain effective working relationships both internally and externally with employees, Attend monthly meeting with company doctor and LTD provider to discuss active claims.
• Communicates with the employee, in a timely fashion, regarding an absence related to an occupational or non-occupational event. Explains the roles and responsibilities of the employee, union if applicable, People Leader, and Claims Team. Discusses and offers early and safe return to work. Forwards appropriate forms for completion with timelines for completion.
• Arrange for Independent Medical Exam or 3rd party consult, as required
• Educates People Leaders, employees and unions about the Abilities Management Program on their roles and responsibilities, which includes ability leave management, early and safe return to work, temporary and permanent accommodations, and sick day administration.
• Works with payroll to determine and process appropriate payments including researching payroll history, as relating to WSIB or LTD claims or other circumstances.
• Identifies opportunities to streamline or automate processes to continuously improve service delivery
• Ensures compliance to legislative, regulatory and Health & Safety policies, procedures and standards as it relates to the role of Specialist, Claims and Abilities
• Performs other duties as assigned

Education & Specialized Knowledge:

• University degree or diploma in relevant discipline of Occupational Health, Safety, Disability Management or Human Resources related fields
• Knowledge of provincial safety act and WSIB legislation in the Occupational Health field
• Knowledge of Occupational Health and Safety Management Systems or Claims technology applications, would be an asset
• Proficiency with MS Office applications

Experience

• Minimum of 3 to 5 years’ experience in claims and abilities management
• Strong experience in the areas of early and safety return to work programs and processes, and short and long term disability programs
• Experience in a unionized utility environment an asset
• High degree of tact, diplomacy and discretion in dealing with confidential, sensitive information
• Solid problem-solving and analytical skills with excellent attention to detail and the ability to provide practical and/or innovative solutions to complex technical issues
• Strong written and presentation skills, with the ability to explain technical information in an organized and concise way
• Ability to organize, plan, prioritize and execute multiple tasks and competing priorities within established timelines in a fast paced environment
• Ability to build and maintain collaborative working relationships with internal and external customers
• Advanced problem-solving skills and the ability to work independently
• Highly skilled in providing consultation and communication on ESRTW program
• Ability to manage difficult conversations and situations, manage escalations;ability to manage conversations and situations with tact and control
• Must hold and maintain a valid class “G” driver’s license

How to Apply

If you would like to be considered for this position and meet the qualifications, please submit your resume by clicking on the button below.

Alectra is an equal opportunity employer and is committed to providing a recruitment process that respects the dignity and independence of all candidates. Should you require accommodation at any stage in the recruitment, assessment and selection process please consult with Alectra’s People Team.

We thank all applicants for their interest in a career with Alectra. Only those selected for an interview will be contacted.