Claim Manager

6 months ago


Kingston, Canada THE EMPIRE LIFE INS. CO Full time

**Summary**

The Claim Manager applies disability management best practices to effectively manage the payment, expenses and risk associated with weekly indemnity and long-term disability claims within approved authority limits. The incumbent is guided by defined procedural constraints, and works under the moderate supervision of the Manager, Life and Disability Claim Management.

**Responsibilities**- Investigate, evaluate and determine eligibility for initial and ongoing payment claims based on medical information, job requirements, non-medical factors, contract terms and department/industry protocols within established service standards- Manage active claims duration by utilizing best practices- Interview claimants and employers through telephone interviews- Ensure accurate and timely documentation of all communication with customers- Formulate and implement a detailed case management plan on each file with a focus on a timely, sustainable and safe return to work; interact with and appropriately challenge treating physicians and employers; make referrals for independent medical assessments and to alternate insurance organizations (federal, provincial and private insurers)- Collaborate with in-house return to work facilitators to design and monitor return to work programs- Collaborate with team members to exchange ideas, gather information and offer solutions on claims- Based on department standards, ensure proactive communication with our customers regarding claim status and developments- Accountable for positive file resolution and appropriate outcomes

**Skills / Knowledge / Education**- Completion of a university degree in anatomy, biology, kinesiology, life sciences or psychology- 3+ years work experience in disability claim management- Knowledge of medical terminology and Disability Management best practices/protocols- Knowledge of relevant provincial employment legislation and legal requirements-
- Bilingual (English/French) is an asset- LOMA 280, 290, HIAA, CEBS - GBA are assets- Well-developed verbal/written communication and interpersonal skills- Well-developed customer relations skills- Ability to work independently and as a collaborative team member- Ability to prioritize and balance multiple tasks- Ability to research, analyze, evaluate, negotiate, make decisions and resolve problems**Working Conditions**- Office environment- Prolonged periods of concentration and attention to detail- Prolonged periods of sitting while using a computer and/or telephone- Frequent interruptions with tight timelines- The incumbent may be required to work extended hours and/or overtime- Frequent contact with emotionally distraught and upset/angry people- Interactions:
- Empire management and employees on a local and national basis-
- Employers, employees and clients who purchase Company products-
- Third party providers including health care provider offices, medical professionals, legal firm representatives, security and surveillance companies-
- Industry associations and government agencies-
- Other insurance companies and financial institutions


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