Claims Service Representative
3 weeks ago
**Job Summary**:
**Early Shift**: (7:55 a.m. - 4:30 p.m.)
1 Bilingual Designated Permanent Position
Acts as the primary point of contact for responding to and resolving claim and coverage related telephone inquiries from workers, employers, representatives, healthcare practitioners, and other service providers received in the Claims Service Centre or when Adjudicators or Case Managers are not available.
**Job Duties**:
The Claims Service Representative is responsible for creating new claim files, ensuring Workers Compensation coverage, accepting specific no time loss claims, and managing each inquiry to a resolution that provides for customer satisfaction and meets organizational standards and objectives. Uses effective listening and questioning techniques to determine each customer's need(s); identifies, evaluates and determines alternatives to problem solve. When unable to resolve an inquiry prior to the end of the call, takes steps necessary for resolution immediately following the call or arranges for an Adjudicator or Case Manager to resolve on a timely basis.
Follows established procedures to create new claim files, input data, search the database, and verify and collect information by calling for, or requesting reports from injured workers, employers and healthcare providers. Notifies the appropriate internal parties at time of reporting of a serious accident or fatality.
Follows department standards for gathering, reviewing, and assessing information to establish Workers Compensation coverage for new claims, communicating decisions to affected parties where appropriate, and referring to the Supervisor or Assessment Services in cases where further action is necessary.
Accepts no time loss claims (Complexity A) within defined parameters. Claims requiring further investigation or approval are forwarded to Adjudicators for review.
Utilizes each inquiry as an opportunity to address customer concern(s) and anticipate future needs, reviewing outstanding or future claim file tasks when appropriate.
Identifies workers in crisis and refers to an appropriate WCB resource.
Reviews the claim file and approves medical expenses within specified guidelines and authority levels. Manages claim owner approved wage loss issues. Refers inquiries that are highly unusual, complex or above authority levels to the appropriate Adjudicator or Case Manager.
Updates claim files as part of each call; clearly documents customer communication including any information gathered, entitlement decisions made, actions taken and claim tasks created.
Provides coverage at the main reception desk.
Completes statistical coding of claims within quality and timeliness standards.
Performs other related duties as assigned.
**Qualifications**:
Completion of a two (2) year diploma in a related discipline (Business Administration)
Typing speed of 35 w.p.m. (error rate less than 5%)
Knowledge of customer service principles and practices
Proficiency in the use of personal computers and software in a Windows environment
Excellent customer service skills including the ability to manage potentially confrontational situations with tact and diplomacy
Well-developed verbal and written communication skills to deal with internal and external stakeholders
Ability to obtain, assess and evaluate information through claim file review, listening and/or questioning in order to problem solve and support decision making
Ability to perform detailed and accurate work in a fast paced environment
Ability to work independently and as part of a team
Customer service experience in a call centre environment including knowledge of call centre telephony and technology would be an asset
Knowledge of advanced communication skills such as active listening and de-escalation techniques would be an asset
**Competencies**:
**Essential**:
Client Service Orientation
Interpersonal Communication
Analysis/Problem Assessment
Written Communication
**Very Important**:
Judgment/Problem Solving
Quality Orientation/Attention to Detail
**Important**:
Teamwork
**Additional Information**:
Please note that this position will begin on May 1, 2023 with an 8 week training class. Hours of work during the training period are 8:30 a.m.4:30 p.m. Participation in Compressed Work Week, Additional Day Off (ADO), or a Flexible Work Hours schedule will be suspended during a training class and no extended vacation time will be permitted. Following the training period, regular scheduled hours of work are Monday to Friday, 7:55 a.m.to 4:30 p.m. In exchange for the additional 35 minutes per day of work, you will receive an additional day off (ADO) in each bi-weekly pay period which does not include a statutory holiday.
You may be asked to demonstrate your ability through competency based interviewing and/or testing.
There is a language proficiency evaluation (oral/reading/comprehension/writing) required. The purpose of a language proficiency evaluation is to determine a current emplo
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