Disability Specialist: Appeals

2 weeks ago

Waterloo, Canada Ontario Teachers Insurance Plan (OTIP) Full time

Company Description

OTIP (Ontario Teachers Insurance Plan) is a member-focused, service-driven organization. We are committed to putting our people first by fostering a positive and inclusive work environment, providing a competitive total compensation package and investing in career development. Our team is currently looking for a:
**Disability Specialist: Appeals (Remote Position)**

**Job Description**:

- Maintains an appeal caseload as assigned.
- Receives and reviews all initial appeals for long term disability claims that have been denied or terminated.
- Utilizes appropriate available case management tools in the investigation and assessment of the appealed claims (i.e. reviewing information provided by field visits, surveillance, functional assessment evaluations or independent medical exams, claims records, applicable contractual provisions and established precedents).
- Prepares an appeal file summary clearly documenting their appeal review, investigation and assessment providing rationale for the appeal decision.
- Updates internal systems related to appeal outcomes, ensuring accuracy of data entries for appropriate appeal claim reporting.
- If the recommendation is to maintain the decline or termination claims decision, will make arrangements for the Appeal Committee to review.
- Communicates the Appeal Committee outcomes to the appropriate parties and provides direction to the ongoing claims team regarding claims management if the claim is approved.
- Acts as a senior resource to GL&DC claims employees and managers. This may include taking employee referrals on complex claim situations, contractual interpretation and assigned projects.
- Maintains technical knowledge by attending educational workshops; reviewing publications.
- Supports change within GL&DC and works effectively in a team environment and contributes to overall team goals and workload management.
- Performs other duties with competence, as assigned. May include but is not limited to, the release of information requests, reporting, involvement in arbitrated and litigated files and participation in GL&DC projects.

**Qualifications**:

- A minimum of five years’ experience in long term disability claims adjudication in the insurance field.
- Strong knowledge related to long term disability claims management and payments, insurance principles and practices, industry standards, and legal and contractual obligations.
- Exceptional communication skills and the demonstrated ability to deal effectively with all levels of internal and external stakeholders.
- Superior time management and organizational skills to manage competing priorities, including project management skills.
- The ability to communicate in French is preferred.

Additional Information
**What we offer**:

- Competitive salary and bonus structure
- Industry-leading employer-paid group benefits that start on your first day
- Defined benefit pension plan
- 100% coverage of continuing education and licensing fees (including RIBO and AIC courses)
- Flexible work from home and hybrid options
- Opportunities for advancement
- OTIP and its group of companies strive to create an accessible and inclusive work environment where everyone is treated with respect and dignity. Upon individual request, we will endeavour to remove any barrier to the recruitment and selection processes and provide accommodations for persons with disabilities._
- As a business, we protect what matters most to our members. As an employer, we value what matters most in our workplace. Together, this includes fostering a diverse, equitable and inclusive environment for all. We are committed to learning and evolving so we can continue to celebrate what makes us special. You are who you are, and our differences are what make us unique._

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