Disability Claims Management Specialist 2

23 hours ago

Burnaby, Canada Pacific Blue Cross Full time

Pacific Blue Cross has been British Columbia's leading benefits provider for 80 years. We are an independent, not-for-profit society with strong roots in BC’s health care system. Together with our subsidiary BC Life, we provide health, dental, life, disability and travel coverage for approximately 1.5 million British Columbians through employee group plans and through individual plans for those who do not have coverage with their employers.

We are fueled by a commitment to keep health care sustainable for all British Columbians. Through our Community Connection Health Foundation, we also provide funding to community organizations with a focus on alleviating mental illness and chronic disease. We're interested in finding people who want to make a difference and who will take advantage of every opportunity to build a career with us.

Pacific Blue Cross offers an attractive compensation and benefits package, fitness programs, and an onsite gym and cafeteria. Our workplace culture values health and wellness, continuing education, environmental sustainability and giving back to the community.

If you are committed to improving the health and well-being of British Columbians, we are currently recruiting for two
**Disability Claims Management Specialists** to join our Work & Wellness team This is a permanent, full-time role, and will require working 2 days per week at the office.

***

**Key Accountabilities**:
**_BC Life Disability Claims Adjudication, Assessment, Intervention and Case Management_**
- Provides the full range of professional Short Term, Long term disability, life claims, critical illness, and waiver of premium claims services to insured and non-insured clients.
- The Disability Case Manager proactively manages claims within contractual terms and conditions of eligibility and coverage.
- Responds to first level appeals for declined claims by reviewing and analyzing new information provided by claimants and/or physicians, seeking further interpretations from medical consultants, conducting reassessments of information on the claim file, and presenting cases to the Disability Claims Review Committee with rationale and recommendations for further consideration or to validate the original decision.

**_Customer, Client and Member Service_**
- In consultation with the Disability Supervisor, actively participates in regular conference calls with selected groups to build trust, facilitate relationship building, answer questions on case management approaches and practices, and to provide input on claims trends and activities for Underwriting’s use in conducting renewal reviews. May attend on site visits with clients to gain exposure to employer or industry environments and working conditions.

**Qualifications**
- Certificate or diploma in Health, Psychology, Kinesiology, Nursing, Disability Management or Business program, or combination of education and experience in the medical field
- Minimum of 3 years previously related experience in disability case management, with demonstrated experience in claims assessment up to the point of intervention
- Experience with LTD case management would be an asset
- Broad knowledge of Contract Provisions and Medical Terminology
- Demonstrated decision making and critical thinking skills
- Demonstrated oral/written communication skills
- Demonstrated proficiency in Basic Word and Basic Excel

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