Claims Processing Specialist
4 weeks ago
Late Shift:
(10:25 :00 )
Up to 2 Permanent Positions
The Claims Processing Specialist serves as the main contact for addressing and resolving inquiries related to claims and coverage from various stakeholders, including workers, employers, representatives, healthcare professionals, and other service providers, either through the Claims Service Centre or in the absence of Adjudicators or Case Managers.
Key Responsibilities:
This role involves establishing new claim files, verifying Workers Compensation coverage, accepting specific no time loss claims, and managing inquiries to ensure customer satisfaction while adhering to organizational standards and objectives.
Employs effective listening and questioning techniques to ascertain customer needs; identifies, evaluates, and formulates alternatives to resolve issues.If an inquiry cannot be resolved during the call, the specialist will take necessary steps for resolution post-call or coordinate with an Adjudicator or Case Manager for timely resolution.
Adheres to established protocols for creating new claim files, entering data, searching databases, and collecting information by contacting injured workers, employers, and healthcare providers.
Notifies relevant internal parties when a serious accident or fatality is reported.Follows departmental standards for gathering, reviewing, and assessing information to determine Workers Compensation coverage for new claims, communicating decisions to relevant parties when appropriate, and referring cases requiring further action to the Supervisor or Assessment Services.
Accepts no time loss claims (Complexity A) within defined parameters, forwarding claims needing further investigation or approval to Adjudicators for review.
Utilizes each inquiry as an opportunity to address customer concerns and anticipate future needs, reviewing outstanding or upcoming claim file tasks when suitable.
Identifies workers in crisis and refers them to appropriate WCB resources.
Reviews claim files and approves medical expenses within specified guidelines and authority levels. Manages wage loss issues approved by claim owners. Refers unusual, complex, or high-authority inquiries to the appropriate Adjudicator or Case Manager.
Updates claim files as part of each interaction; meticulously documents customer communications, including gathered information, entitlement decisions, actions taken, and created claim tasks.
Provides coverage at the main reception desk.
Completes statistical coding of claims within quality and timeliness standards.
Performs other related duties as assigned.
Qualifications:
Completion of a two (2) year diploma in a relevant field (Business Administration)
Minimum two (2) years' experience in interpreting and applying processes and procedures to manage and resolve customer inquiries/concerns
Typing speed of 35 (error rate less than 5%)
Knowledge of customer service principles and practices
Proficiency in using personal computers and software in a Windows environment
Excellent customer service skills, including the ability to handle potentially confrontational situations with tact and diplomacy
Well-developed verbal and written communication skills to engage with internal and external stakeholders
Ability to interpret and apply processes and procedures, including those related to WCB Adjudication and Case Management
Ability to obtain, assess, and evaluate information through claim file review, listening, and/or questioning to problem solve and support decision-making
Ability to perform detailed and accurate work in a fast-paced environment
Ability to work independently and collaboratively within a team
Customer service experience in a call center environment, including knowledge of call center telephony and technology, would be an asset
Knowledge of advanced communication skills such as active listening and de-escalation techniques would be an asset
Additional Information:
Salary Range:
$55,684 - $69,603
The Claims Processing Specialist (CPS) is an entry-level position that provides the knowledge and experience necessary for advancement into various roles within the WCB.
The WCB is committed to career development and promoting from within, with many CPSs beginning their careers in this role.
A satisfactory criminal record check and verification of education will be required for the successful candidate.
The WCB is dedicated to building a skilled, diverse workforce with equitable representation of Indigenous persons, visible minorities, persons with disabilities, women, LGBTTSQ+ persons, and members of other equity-seeking groups.
Applicants are encouraged to indicate in their covering letter or resumé if they are a member of these groups.
The WCB recognizes that individuals may face barriers that hinder their full and equal participation in the workplace and is committed to providing reasonable accommodation to all employees and candidates who may be disabled by one or more barriers in the workplace.
Accommodations are available upon request for candidates participating in all aspects of the selection process.
ABOUT WCB:
The Workers Compensation Board promotes safety and health in Manitoba workplaces and aims to help prevent and reduce the occurrence of workplace injuries and diseases.
Working with its partners, the WCB promotes safe and healthy workplaces, facilitates recovery and return to work, provides compassionate and supportive compensation services for workers and employers, and ensures responsible financial stewardship.
WCB encompasses what it means to work at the WCB.
The WCB is proud to offer employee benefits and programs that support financial and personal security, foster health and well-being, encourage involvement, and support growth as an individual and member of the WCB community.
The four categories of WCB include:
Security, Wellness, Engagement, and Growth.
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