Manager, Appeals

3 weeks ago

Waterloo, Canada Ontario Teachers Insurance Plan (OTIP) Full time

Company Description

OTIP (Ontario Teachers Insurance Plan) is a member-focused, service-driven organization. We are committed to putting our people first by fostering a positive and inclusive work environment, providing a competitive total compensation package and investing in career development. Our team is currently looking for a:
**Manager, Appeals & Resolutions**

**Job Description**:

- Manages the department and coordinates activities to achieve operational efficiency while adhering to the strategic plan. Analyzes needs and directs changes as required.
- Applies quality principles and practices to establish a strategic approach and improve the organization’s operations and productivity. This includes managing processes to support the organization’s strategic direction and communicating, facilitating and supporting necessary changes for continuous improvement.
- Establishes strategic initiatives and accomplishes financial objectives. This includes gathering pertinent business, financial, service and operations information and forecasting requirements to prepare an annual budget and schedule expenditures.
- Provides information to the Director of Claim Operations and Vice President of GL&DC, including annual objectives, business opportunities, results, trends and competitive information.
- Maintains department effectiveness by recruiting, selecting, and coordinating training for direct reports. Also communicates strategies, objectives, and provides employees with the necessary resources to perform individual job responsibilities efficiently.
- Leads the performance management process by communicating job expectations and tracking progress and effectiveness of individual activities. This includes determining team and individual goals, offering job coaching, training, motivation and support to help employees meet objectives and quality requirements, reviewing progress, and offering feedback as required.
- Ensures regular audits are completed in compliance with departmental expectations and standards. This includes analyzing and resolving quality and customer service problems, identifying trends, and recommending improvements.
- Provides information and answers questions to assist team members in determining direction and procedures for complex claims.
- Communicates with members, attorneys, physicians, insurers and senior OTIP staff regarding complex or contentious claims. Informs management of claims status in accordance with departmental standards.
- Works in consultation with Underwriting to settle self-insured legal files. Managing appropriate authority limits for Litigation specialists.
- Ensures vendor resources are used appropriately while monitoring use and costs.
- Prepares and delivers presentations pertaining to appeals, legal actions, group life insurance and ongoing disability claims.
- Collects, analyzes and summarizes information for GL&DC management and for reporting purposes. Prepares and presents data pertaining to appeals, legal actions, group life insurance and ongoing disability claims
- Fosters an effective working relationship with appeals committee representatives, underwriting, benefit services, insurance partners and OTIP’s legal firm representatives.

**Qualifications**:

- A minimum of eight years’ experience in disability claims management including a minimum of five years’ experience in a supervisory role.
- General knowledge of mental health disorders and problems, common physical illnesses and disabilities, personality, functional and vocational assessment tools, cognitive behavioral approaches, and the disability management and rehabilitation process.
- Knowledge of all aspects of group life insurance, AD&D and disability insurance.
- Strong knowledge of insurance principles, practices and contracts, underwriting agreements, and LTD claims services and legal processes.
- Exceptional communication skills and the demonstrated ability to deal effectively with all levels of internal and external stakeholders.
- Superior time management, project management and organizational skills to manage competing priorities.
- HIAA, ICA, FLMI, CDMP, and CEBS designations are considered an asset.
- The ability to communicate in French is considered an asset.

Additional Information
**What we offer**:

- Competitive salary and bonus structure
- Industry-leading employer-paid group benefits that start on your first day
- Defined benefit pension plan
- 100% coverage of continuing education and licensing fees (including RIBO and AIC courses)
- Flexible work from home and hybrid options
- Opportunities for advancement
- OTIP and its group of companies strive to create an accessible and inclusive work environment where everyone is treated with respect and dignity. Upon individual request, we will endeavour to remove any barrier to the recruitment and selection processes and provide accommodations for persons with disabilities._
- As a business, we protect what matters most to our membe

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