Disability Claims Management Specialist 2

4 days ago

Burnaby, Canada Pacific Blue Cross Full time

**About Pacific Blue Cross**

Pacific Blue Cross (PBC) has been British Columbia's leading benefits provider for over 80 years. We are an independent, not-for-profit society with strong roots in BC’s health care system. We provide health, dental, life, disability, and travel coverage to 1 in 3 British Columbians through employee group plans and individual plans.

We are fueled by a commitment to keep health care sustainable for all British Columbians. Through our PBC Health Foundation, we fund projects that improve health outcomes directly related to mental health and wellbeing as well as the prevention and/or management of chronic disease. We are interested in finding people who want to make a difference and who are looking to grow their career with us.

**Perks**
- Work-life balance with flexible working hours of 7 hours per day, Monday to Friday (i.e., 35 hours per week).
- Paid vacation starts at 3 weeks per year, and increases with years of service.
- Hybrid work environment (i.e., a combination of work from office and work from home days).
- Generous benefits, including extended health, dental, and life insurance; these benefit premiums are 100% paid by PBC.
- Company pension contributions after 1 year of service.
- Education allowance up to $1,000 per calendar year.
- Onsite gym, cafeteria, and access to virtual doctors/counsellors 24/7 via our Employee Family Assistance Program

**About the Position**
- We are searching for 1 **Disability Claims Management Specialist 2 **to join our Work & Wellness department.
- This position is unionized and part of the CUPE 1816 Bargaining Unit. This position is paid at hourly rates and receives wage increases in accordance with the Collective Agreement. The starting wage for this position is: $35.85 per hour.

**Job Summary**

Under the general supervision of the Supervisor, Work & Wellness (W&W), the Disability Claims Management Specialist 2 provides the full range of professional disability and waiver of premium claims services to insured clients and Administrative Services Only (ASO) applicants undergoing review, and ensures claims are coordinated and managed within contractual terms and conditions of eligibility and coverage including reviewing, analyzing, and investigating claims information from a variety of sources, determining adjudication, assessment and intervention actions affecting short
- and long-term disability claims management, payment and duration including those of a complex nature; develops cost/benefit analyses; develops case management plans; coordinates settlements; coordinates referrals to internal stakeholders for rehabilitation; coordinates the use of external service providers; develops and implements return-to-work initiatives and conducts reviews of ongoing cases; responds to appeals for declined claims; manages claimant and client relationships; and, actively participates in conference calls with selected groups to build ongoing relationships.

**Job Duties**

**Disability Claims Adjudication, Assessment, Intervention and Case Management**
- Provides the full range of professional disability and waiver of premium claims services to insured clients and ASO applicants undergoing review, and ensures claims are coordinated and managed within contractual terms, conditions of eligibility, and coverage by:

- reviewing, analyzing, and investigating claims and history/conditions of claimants to determine eligibility information from a variety of sources as well as requesting and documenting additional information as required.
- and long-term disability claims.
- identifying and following up on variances in policy and structure set up in the claims adjudication system or other deficiencies such as variances between policy provisions and eligibility.
- investigating pre-existing conditions and other policy exclusions to determine impact on eligibility and valuation.
- deciding on the acceptance or denial of the claim and other decision outcomes, preparing, and documenting the rationale for the decision, making internal round table presentations to colleagues and management to ensure claims-related decisions meet professional and quality standards, and communicating the final decision to claimants and employers.
- developing initial and ongoing cost-benefit analyses for intervention options and case management plans to identify the most cost-effective approach to managing disability claims without compromising on contractual obligations; estimates probable and potential outcomes and factors those outcomes into the development and costing of the case management plan.
- developing case management plans and early intervention including setting plan expectations and outcomes, preparing, and referring case files to external stakeholders for assessments and medical treatment and management such as clarifying objectives of the referral and coordinating return to work plans with the employer. Coordinating referrals to internal stakeholders for rehab

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