Disability Claims Specialist

2 weeks ago

Toronto, Canada Desjardins Full time

At Desjardins, we believe in equity, diversity and inclusion. We're committed to welcoming, respecting and valuing people for who they are as individuals, learning from their differences, embracing their uniqueness, and providing a positive workplace for all. At Desjardins, we have zero tolerance for discrimination of any kind. We believe our teams should reflect the diversity of the members, clients and communities we serve.

Job Level

NV-07

As a Disability Claims Specialist - Case Manager, you help process life and health insurance claims, promote occupational health, and manage disabilities.

You serve as technical expert and provide discipline-specific support for your unit’s activities, initiatives, and processes. The ability to tailor your approach as needed is therefore essential. You research and analyze processes, information management and data processing.

You draw on your sound decision-making skills to solve technically complex problems and recommend ways to change or adjust methods and procedures to make them as effective and efficient as possible.

General Information on the Position

Main responsibilities- Communicate by phone and mail with claimants, policyholders, administrators, other insurers, physicians, government pension plans, workers’ compensation boards and other stakeholders regarding claims. Document follow-up efforts- Process disability claims in accordance with the terms of the group insurance contract- Communicate with the insured and the policyholder to obtain all the information required to establish the causes and context of the absence- Approve and adjudicate claims for disability benefits and process waivers of premium. Communicate its decision to the insured and the policyholder according to the defined process- Carry out specialized technical studies, research, and analysis. Serve as resource person for the submission of solutions and action plans (diagnosis, intervention plan, treatment plan, return-to-work plan, disability monitoring, etc.)- Establish an intervention plan to facilitate the insured's recovery and return to work in a timely and sustainable manner for each case of absence treated. Communicate to the insured and the policyholder the content of the intervention and return to work plan and inform the HR practitioner, if applicable, while respecting the confidential information in the file- Define the framework of any personalized support mandate that will be entrusted, at its discretion, to a disability management practitioner or a health professional- Continuously monitor the implementation of this mandate and, when necessary, make the appropriate adjustments as the situation evolves- Establish the amount of the benefit, determine the period payable, proceed with the payment and ensure the necessary follow-ups. Codify and enter data into the appropriate systems- Maintain good relations and act in partnership with external partners involved in absence management- Collaborate in the search for continuous improvement in relation to activities related to disability management and work in collaboration with peers- Prepare documents needed by the organization’s rehabilitation coordinator for claimant interviews. Review claims with medical consultants and the legal department as required.

Other working conditions- The work arrangement for the position is hybrid work #LI-Hybrid (depending on the applicant selected other work modes may be considered)- Number of jobs available: 3

**Qualifications**:
- College diploma in a related field- A minimum of three years of relevant experience, including two years in a similar position in group insurance- Experience in the health care field (an asset)

Please note that other combinations of qualifications and relevant experience may be considered

Desjardins Cross-sector skills

Action oriented, Customer Focus, Differences, Nimble learning

Key competencies for the job

Communicates effectively, Decision quality, Situational adaptability

Work Location

95 St-Clair Avenue West Toronto

Trade Union

Non Syndiqué

Unposting Date

2023-06-26

Job Family

Life and health insurance (FG)

Desjardins Group is the largest cooperative financial group in Canada, and one of the largest employers in the country. It offers a full range of financial products and services and is home to a wealth of expertise in property and casualty insurance, life and health insurance, wealth management, services for businesses of all sizes, securities brokerage, asset management, venture capital, and secure, leading-edge virtual access methods.

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