Eligibility Adjudicator

3 weeks ago

Toronto, Canada Workplace Safety and Insurance Board Full time

Our priority is the health and wellness of employees and the people of Ontario. As such, this position may involve working from home for part of the duration of this position. The WSIB model mixes working from home, office and field.

About the Workplace Safety and Insurance Board (WSIB)

We're here to help. When an injury or illness happens on the job, we move quickly to provide wage-loss benefits, medical coverage and support to help people get back to work. Funded by businesses, we also provide no-fault collective liability insurance and access to industry-specific health and safety information. We are one of the largest insurance organizations in North America covering over five million people in more than 300,000 workplaces across Ontario. For more information, visit wsib.ca.

At the WSIB, you'll have the opportunity to:

- explore many career paths and follow your passion
- continuously learn and grow professionally
- be recognized for the great work you do
- participate in programs that support your health and wellbeing

You'll also receive a competitive salary, along with a comprehensive benefit package and defined benefit pension plan.

The WSIB is recruiting for current and future unilingual and bilingual (French speaking) opportunities in the following locations:
Guelph, Hamilton, Kingston, Kitchener, London, North Bay, Ottawa, Windsor, Sault Ste. Marie, Sudbury, Thunder Bay, Toronto, Timmins & Windsor

There may be a requirement to work 9:15am to 5:15pm

From: $74,740.50

**OPS Commitment to Diversity, Inclusion, Accessibility, and Anti-Racism**: We are committed to build a workforce that reflects the communities we serve and to promote a diverse, anti-racist, inclusive, accessible, merit-based, respectful and equitable workplace.

Visit the
**OPS Anti-Racism Policy** and the
**OPS Diversity and Inclusion Blueprint** pages to learn more about the OPS commitment to advance racial equity, accessibility, diversity, and inclusion in the public service.

We offer employment accommodation across the recruitment process and all aspects of employment consistent with the requirements of Ontario's
**Human Rights Code**. Refer to the "How to apply" section if you require a disability-related accommodation.

**What can I expect to do in this role?**: Use a proactive case management approach to make and communicate eligibility decision on benefits and services in a timely fashion that are consistent with relevant WSIB policy. Address worker and employer needs by actively listening, collecting and proving relevant information, and helping the workplace parties understand their rights, responsibilities and obligations.

Manage cases that are allowed, denied, reconsidered or resolved within established program guidelines, following a structured case management framework to enable them to achieve high quality eligibility decisions and successful outcomes.

**How do I qualify?**:
**Major Responsibilities**: 1. Inform parties of their rights, responsibilities and obligations under the WSI Act and applicable legislation, and the consequences of non-compliance.

2. Proactively collect information from workplace parties and healthcare providers required for eligibility decisions and respond to inquiries.

3. Assess case and plan towards best outcomes. Make eligibility decisions quickly and accurately and communicate them, verbally and in writing by determining the following:

- The employer is covered under the Act;
- The worker is employed by the employer at the time of the injury;
- The injury is work-related;
- Proof of accident can be established;
- The diagnosis is compatible with the accident;
- Continuity and compatibility support ongoing entitlement in the case of recurrence;
- Ensuring accident reporting compliance with the employer.

4. Support workplace parties in their return to work (RTW) efforts by sharing any available information about the workers' capabilities and/or precautions.

5. With the assistance of Payment Specialists where required, ensure appropriate earnings information is on file in order to determine the appropriate duration and level of benefits.

6. Review and monitor cases until closure or transition to a Case Manager, assessing RTW and recovery factors to differentiate cases requiring Case Manager expertise.

7. Refer requests to appropriate internal WSIB parties (Nurse Consultant, Account Specialist, Legal Services) to gain their expertise on various components of a claim when the need for appropriate intervention is recognized and follow up with them as required.

8. Attempt to prevent or resolve disputes, handle requests for reconsideration and, if unresolved, arrange access and process the objection.

9. Perform other related duties as assigned or required such as participation in the development and implementation of business plans and projects.

**Job Requirements**: Education
- University completion at undergraduate level.

Experience
- Two years prior experience in adjudic

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