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Specialist, Claims
5 months ago
The Opportunity
Job Posting Number:
**2024-017**
Position:
**Specialist, Claims & Ability
**Location**:
**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
Hours per Week:
**35**
Rate of Pay:
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 Rehabilitation Earnings 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
