Disability Management Specialist
3 weeks ago
Organizational Solutions Inc. (OSI) is a Third party provider who specializes in Disability Management, believing in the quality of growth and the professional potential of all our staff. Founded in 2003, OSI’s journey is one of entrepreneurial achievement and professional development. Over the past fifteen years we have grown from a grassroots start-up into one of Canada’s leading Disability Management and Workers’ Compensation Claims management providers. Today OSI employs more than 130 highly specialized people and serves over 1,000 clients of all sizes in almost every industry.
As a member of OSI you can have the opportunity to work in an innovative environment and to engage in meaningful work and having a strong positive impact in providing, The Right Care, at the Right Time, for the Right Outcome©.” within a dynamic, and talented team, while growing your own professionalism.
**Overview / General Purpose**:
The Disability Management Specialist role is responsible for managing the day to day disability claims (STD / LTD / Accommodations) for clients, assist in facilitating recovery, and promoting early and safe return-to-work for clients’ employees. They live to OSI’s values of return to work and recovery. Disability Management Specialists will communicate with key stakeholders in order to adjudicate, manage, return-to-work planning, and reporting. Support Disability Management Coordinator (DMC) and Abilities Assessor (AA) on complicated files. In conjunction with the performance of claims adjudication, claims management, and return to work. The Disability Management Specialist will also evaluate historic claims performance and work collaboratively with our team to provide solution-focused programs, and develop best practices for claims and care management, for ongoing and new clients. Establish and maintain positive client relationships. Deliver quarterly and annual reports with continuous improvement focus.
**Primary Duties and Responsibilities**:
- Adjudication of all claims in accordance with client and OSI policies
- Enter detailed info into internal management system
- Manage all claims with a RTW focus and for the lowest duration
- Facilitation of return to work, as soon as possible
- Work as part of a team internal and externally with client
- Partner with client to understand workplace
- Provide continuous improvement impact
- Manage all claims with a high degree of excellence
- Manage all complicated claims including but not limited to psychological claims
- Evaluate medical and workplace information to determine if key elements are present
- Explore innovative technologies to reduce durations, i.e. cognability, pharmacogenetics
- Develop outcome focused recovery and RTW plans
- Communicate the employee’s functional capabilities to the employer to determine if the employer is able to provide modified duties in the return to work planning
- Facilitate RTW consistently with a Transitional Return to Work Plans (TRTWP)
- Finalize annual reports to be presented to client
- Coach and mentor other disability management staff by enhancing their knowledge and education levels
- Determine when additional tools are to be used at the appropriate times (i.e.: IME / FCE, refer to rehabilitation, medical consultant, pharmacogenetics, or workstation evaluations etc.)
- Ensure the employee is receiving optimal treatment at all times
- Facilitate treatment plan with treating physician and / or specialist
- Conduct detailed phone functional interviews regarding activities of daily living (ADL) while providing tips to reduce barriers
- Interact with other to enhance claim outcomes
- Provide support to AA, DMC, and guidance on client specifics and decision process / protocol
- Aware of status on claims at all times, ensuring internal system is fully updated
- Provide strong strategies to reduce claim duration
- Organize and participate in monthly client calls and meetings
- Brainstorm with Team Lead on any claims over 30 days
- Calculate and communicate benefit payment amount for specific clients on their approved claims for each relevant pay period to both the employee and the employer to be paid out by the client or OSI
- Monitor the progressive return to work plans
- Follow up with any missing claim actions or information
- Ensure reported comments updated at least weekly
- Review monthly reports
- Act as Client Lead on non CL accounts
- Review and deliver annual and/or quarterly report, where no Client Lead is in place, with positive and continuous improvement focus
- Work collaboratively as part of client team
- Participate in brainstorming and committees to advance OSI, i.e. training, social committee, etc.
- Establish individual goals consistent with organizational focus and client deliverables
**Required Competencies**:
- Registered professional designation / certification or working towards is an asset: (RN, RPN, Kin., RRP or other related healthcare background; Certified Disability M
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