Disability Claims Management Specialist 2

Disability Claims Management Specialist 2 Join to apply for the Disability Claims Management Specialist 2 role at Pacific Blue Cross About Pacific Blue Cross Pacific Blue Cross (PBC) has been British Columbia's leading benefits provider for over 80 years. We are an independent, not-for-profit society with strong roots in BC’s health care system. We provide health, dental, life, disability, and travel coverage to 1 in 3 British Columbians through employee group plans and individual plans. We are fueled by a commitment to keep health care sustainable for all British Columbians. Through our PBC Health Foundation, we fund projects that improve health outcomes directly related to mental health and wellbeing as well as the prevention and/or management of chronic disease. We are interested in finding people who want to make a difference and who are looking to grow their career with us. Perks Work‑life balance with flexible working hours of 7 hours per day, Monday to Friday (35 hours per week). Paid vacation starts at 3 weeks per year, and increases with years of service. Hybrid work environment (combination of work from office and work from home days). Generous benefits, including extended health, dental, and life insurance; these benefit premiums are 100% paid by PBC. Education allowance up to $1,000 per calendar year. Onsite gym, cafeteria, and access to virtual doctors/counsellors 24/7 via our Employee Family Assistance Program. About the Position 1 temporary position (up to 12 months) Disability Claims Management Specialist 2 in Life and Disability department. Unionized position part of CUPE 1816 Bargaining Unit. Hourly rates paid with wage increases per Collective Agreement. Wage: $5,754 - $8,420 per month. Job Summary Under the general supervision of the Supervisor, Life and Disability, the Disability Claims Management Specialist 2 provides full range of professional disability and waiver of premium claims services to insured clients and ASO applicants, ensuring claims are coordinated and managed within contractual terms and conditions of eligibility and coverage. This includes reviewing, analyzing, investigating claims, determining adjudication, assessment and intervention actions affecting short‑ and long‑term disability claims, developing cost/benefit analyses, case management plans, coordinating settlements, referrals, return‑to‑work initiatives, responding to appeals, managing relationships, and participating in conference calls. Job Duties Disability Claims Adjudication, Assessment, Intervention and Case Management Provides full range of professional disability and waiver of premium claims services, ensuring claims coordinated within contractual terms, eligibility, and coverage. Review, analyze, investigate claims and history/conditions of claimants to determine eligibility and request additional information. Interpret and apply contract wording, medical documentation, claims policies and procedures, statutory requirements, and other guidelines for valuation and disposition of claims. Identify and follow up on variances in policy and structure within the claims adjudication system. Investigate pre‑existing conditions and policy exclusions to determine impact on eligibility and valuation. Conduct telephone interviews or written communication with claimants and stakeholders to gather information and determine level of functionality, accommodation status, return to work, and interventions. Decide acceptance or denial of claims, prepare documentation of rationale, present to colleagues and management, and communicate final decisions. Develop initial and ongoing cost‑benefit analyses for intervention options and case management plans, estimating outcomes and incorporating them into planning. Develop case management plans and early interventions, coordinate referrals to external stakeholders for assessment and treatment, clarify objectives, and coordinate return‑to‑work plans. Coordinate and oversee services of treatment providers to facilitate recovery. Coordinate and oversee internal and external rehabilitation services. Develop, implement, and monitor return‑to‑work initiatives. Review high‑intervention short‑ and long‑term disability cases to optimize treatment and return‑to‑work planning. Check system‑generated payment calculations for accuracy, perform manual calculations, override system limitations, and ensure accurate coding. Identify and calculate recovery amounts for overpayment situations, communicate expectations, and follow up. Ensure documentation and claim status continually updated in systems. Respond to appeals for declined claims per established processes, request and analyze new information, present cases to Leadership Review Committee. Maintain liaison with re‑insurers, complete complex case action plans, refer claims to leadership, and escalating as needed. Customer, Client, and Member Service Plan and compose various written correspondence and reports adhering to communication standards, style guidelines, privacy legislation, and confidentiality. Manage claimant and client relationships, keeping stakeholders informed and providing timely responses. Escalate non‑W&W concerns to appropriate areas within PBC or other Blue Crosses. Participate in conference calls to build trust and provide input on claims trends. Attend onsite visits with clients as needed. General Team and Department Support Maintain up‑to‑date knowledge of disability management best practices, policies, legal compliance, and system requirements. Support team members and new employees on task execution and knowledge sharing. Perform other duties related to disability claims management not affecting rating of the job. Qualifications High school graduation, or equivalent. Completion of a 1‑year Disability Management Diploma (288 hours), or equivalent. Demonstrated proficiency in basic Word and Excel. 3 years of previous related experience in disability claims management, including 2 years in a Disability Claims Specialist or Disability Claims Management Specialist 1 position, or equivalent. Demonstrated proficiency in disability claims management including assessment, oversight of interventions and claim resolution. If you’re excited about taking on this opportunity, we invite you to apply today and start the conversation with us about this position. Together we can create a healthier British Columbia through teamwork, exceptional service and accountability that will help improve sustainable healthcare. Please apply via our website this week at http://www.pbchbs.com/company/careers/. While we thank all applicants for their interest, only short‑listed candidates will be contacted. Diversity, Equity, and Inclusion PBC is an Indigenous Works employer of choice, an Insurance Business Canada Diversity, Equity, and Inclusion award winner, one of Canada’s Greenest employers, a Canadian Centre for Diversity and Inclusion (CCDI) employer partner, and a Pride at Work partner. We strive to create a workplace where everyone feels valued and employees feel empowered to freely participate and contribute regardless of Indigenous identity, race, colour, ancestry, place or origin, political belief, religion, marital status, family status, physical or mental disability, sex, sexual orientation, gender identity or expression, age, physical or mental disability. We are an equal opportunity employer and welcome applications from all qualified candidates. To request an accommodation in completing this job application, testing, interviewing, or otherwise participating in the employee selection process, please direct your inquiries to careers@pac.bluecross.ca. These accommodation requests will be reviewed confidentially and, on a case‑by‑case basis by Human Resources. #J-18808-Ljbffr