Disability Claims Specialist

5 days ago

New Brunswick, Canada Medavie Blue Cross Full time

For over 75 years, Medavie Blue Cross has been a leading health and wellness partner for individuals, employers and governments across Canada. As a not-for-profit organization, we proudly invest in communities to help address some of Canada’s most pressing health care challenges. We are one of Canada's Most Admired Corporate Cultures, one of Canada’s Top 100 Employers, Canada’s Life & Health Insurer of the Year for 2021 and an Imagine Canada Caring Company.

Our 2,400 professionals work across six provinces, united by our shared values of being caring, accountable, responsible, innovative and community-minded. We’re committed to ensuring our employees thrive in our award-winning, collaborative culture focused on ensuring health, wellness, and personal and professional growth through a variety of programs and support across our organization.

Together with Medavie Health Services, we are part of Medavie — a national health solutions partner with over 7,700 employees. Our mission is to improve the wellbeing of Canadians.

**Job Title**:

- Disability Claims Specialist**Department**:

- Health and Disability**Competition**:

- 86820**Internal/External**:

- Both**Employment Type**:

- Full Time Permanent**Location**:

- NB, Remote Available**Salary**:

- Competitive Compensation**Reports To**:

- Team Lead, Case Management Services As a **Bilingual Disability Claims Specialist** you will be working and collaborating with a team of talented professionals in a high-energy work environment to ensure service level standards are met by managing a block of short or long-term disability cases.

You will support our plan members through illness, recovery and return to work by providing them with disability benefits and proactive case management.

In this role you are responsible for the disability claim adjudication from the initial decision to building the right case management plan which includes but is not limited to: 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. Effective communication and organizational skills are an essential requirement for this role to help ensure all key milestones are met for each case. This position has a start date of May 27th, 2024 and is available full time remote, hybrid or in-office based on your preference.

**Key Responsibilities**:

- Disability claim adjudication; reviewing eligibility of claimant, assessing total disability through the evaluation of medical information, telephone interviews etc.
- Active case management of files; provide ongoing and regular communication with all stakeholders of claim, assess use of claim tools (rehab, IME etc.), review and request ongoing medical as needed, provide ongoing assessment of key dates within the lifecycle of the claim (COD etc.) and ensuring case management plans are updated regularly.
- Accountability and responsibility to ensure that the management of required tasks within the assigned case load meets all service level standards.
- Render decisions on a timely basis and effectively communicate these decisions, at times potentially difficult decisions and manage escalations with employers and claimants.
- Build effective relationships with key stakeholders and claimants to support recovery and return to work.
- Effective and consistent use of an electronic case management system (Fineos).

**Qualifications**:

- **Education**: Post-secondary degree completed in Health Sciences (Kinesiology, Psychology, Rehabilitation, Social Work, Nursing, Clinical/Medical Office Administration) or a related field
- **Work Experience**:1 to 3 years relevant experience. Background in a health-related field or case management would be an asset.

**Other Qualifications & Assets**:

- Professional written and verbal communication skills to successfully partner and influence various stakeholders including the claimant, their treatment providers and physicians, the employer, group administrators, human resources, and lawyers.
- Strong organization and prioritization skills required to manage different type of tasks
- Excellent customer service and telephone skills with the ability to communicate complex and difficult information clearly with tact and sensitivity. At ease with both incoming and outgoing calls.
- Strong analytical skills, excellent problem-solving abilities and can work with minimum supervision.
- A general understanding of the health care and insurance fields, health related terminology, concepts of accommodation and return to work.
- Experience and knowledge of managing files related to mental health.
- An understanding of contract wording and the ability to thoroughly review medical reports and other tools available (e.g., Independent Medical Exams, Function Capacity Exams, surveillance, medical consultant reviews) is an asset.

**Computer Skills**: Proficient keyboarding and technical aptitude in Mic

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