Group Benefits Examiner

3 months ago

Sherwood Park, Canada First Canadian Insurance Corporation Full time

First Canadian is a national organization and we are experiencing unprecedented growth

We aim to hire bright, hard-working people who share our values. We seek employees who are committed to learning, career growth, and opportunity. We take pride in being an organization that our employees support long-term. We believe in our employees and celebrate their success by asking for employee opinions and feedback so that we continue to be a Great Place to Work.

We award our team with the following:

- Off work 1 hour early on Fridays.
- Earned Time-Off Program and vacation.
- Group Retirement Savings Plan with employer match.
- Hybrid work options may be available.
- On-site gym including free weekly classes with a qualified trainer.
- Newly renovated facility with ergonomic desks/chairs.
- Educational assistance and career development.
- Employee benefits.
- Health and Wellness spending account.
- Employee Assistance Program (EAP).
- Employee discount programs.
- A Culture Team dedicated to diversity, inclusion, and employee programs.
- Employee recognition and appreciation events.
- French is not required for this role but is an asset, an uplift of 5% is applied after the probationary period for qualified professional level French bilingualism (both spoken and written)

Check out our company page for all the information on why we believe First Canadian is an employer of choice

If you are motivated to succeed by helping people, then this is the opportunity for you

Under the direction of the Life, Disability and Group Benefits Claims Manager, the Group Benefits Claims Examiner is responsible for managing group benefit claims to resolution. This includes determining if the plan members are eligible for benefits, providing appropriate benefit payments, and implementing the right medical and vocational interventions to support recovery and return to work for approved claims.

The hours of work are 8:00am - 5:00pm Monday to Thursday and 8:00am to 4:00pm on Friday.

**Essential Responsibilities**:

- Assessing entitlement under the Group Benefit Program by reviewing and comparing contractual, medical, functional and occupational provisions.
- Conduct functional telephone interviews to understand the scope of the disability, the effect on daily living, assess and identify medical and non-medical influencing factors that may prevent a return to work.
- Ensure compliance of optimal medical treatment to ensure a safe and early return to work.
- Facilitate and monitor outcome-focused case management plans.
- Partner with Employee, Employer, and treating physicians to negotiate and implement modified/gradual Return to Work Programs.
- Enroll and facilitate appropriate vocational and/or rehabilitation services, where appropriate.
- Validate beneficiary recipients; Calculate and release initial and ongoing benefit payment.
- Assess ongoing entitlement per Group Policy provisions.
- Communicate directly with employee, employee representatives, employers, and medical professionals (verbally and in writing).
- Rapport building with employees, employers and medical professionals and ability to maintain professional relationships.
- Delivering an exceptional customer service experience to all employees to which they are assigned as the Claims Examiner.
- Acquire supporting claims documentation through contact and correspondence with employee and employers, medical practitioners, healthcare agencies, pharmacies.
- Define extent of FCIC financial liability for any assigned claim; complete timely and appropriate data updates to manage financial reserve adequacy for the duration of claim.
- Adhere to all established operational procedures for adjudication of all claims.
- Draft professional external correspondence and as necessary reference technical Group Policy language and claim entitlement rationale on all claims files.
- Maintains highly accurate and detailed case notes of all employee contacts, claims activities, and issues affecting ongoing management of the claim to satisfy regulatory and legal compliance requirements.

**Qualifications**:

- 1 year college Certificate /Diploma - Business/Insurance/Legal/Risk is preferred; other academic equivalencies may be considered.
- Medical Terminology/Transcription Certificate, or Medical Office Assistant Certificate, or Unit Clerk considered an asset.
- Minimum of 1-2 years of relatable work experience is preferred in an Insurance, Medical, Legal or Service Call Center setting.
- Highly developed communication skills (verbal and written) in both English and French.
- Previous claims adjudication experience is an asset.

Thank you for considering our organization.

We have a Mandatory Vaccination Policy to ensure employee safety due to COVID-19.

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