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Personal Injury Representative Ii
2 weeks ago
Do you value integrity and innovation? How about passion and caring? Great Us too, and that's why you'll fit right in. Our intentional culture promotes trust and participation, encouraging you to bring your heart and mind to work every day.
In-Scope
Multiple Positions- Permanent- Temporary (6-12-month terms)
Reporting Relationship: Successful incumbents could report to any one of the Injury Claims Managers
Work Location: This role is eligible for hybrid - this means you’ll have the flexibility of working from home and in the office, on a scheduled rotation once training requirements have been met. Until then, the successful incumbent will be expected to work on-site, full-time.
GENERAL ACCOUNTABILITY
The Personal Injury Representative II is responsible for monitoring, evaluating, and coordinating benefits under No Fault Injury Benefits for more complex injury claims. The incumbent focuses on early intervention, through rehabilitation, to help injured persons return to their pre-accident status. Employees in this class work independently and may be required to work away from established headquarters.
KEY ACCOUNTABILITIES
- Note: This section is not intended to be an exhaustive list of duties and responsibilities - other duties and responsibilities may be assigned._- Interviews injured person(s), individually or with family members, to assess the situation, to complete Application for Benefits, and to determine No Fault Injury Benefits coverage entitlement and validity of claim, as determined through interpretation of the AAIA (Automobile Accident Insurance Act) policy wordings, and other current and sometimes past acts and regulations.- Approves, monitors, and redefines rehabilitation plans based on extensive medical and psychosocial information obtained, and/or in consultation with treating practitioners.- Develops, monitors, and redefines, in concert with injured persons, employers, treating practitioners and/or other interested parties, vocational rehabilitation plans which may include Return to Work and Graduated Return to Work Plans.- Evaluates and assesses injury claims based on extensive medical and psychosocial information and formulates benefits based on these assessments which may include Living Assistance Benefits.- Gathers and analyzes employment-related information necessary to calculate Income Replacement Benefits.- Assigns, monitors, and terminates the services of consultants and/or service providers assisting with rehabilitation.- Responds to questions and correspondence from injured person(s), treating practitioners and/or other interested parties regarding the current status of recovery and benefits.- Interviews injured person(s) to evaluate the progress of their recovery, to ensure that the terms specified in the treatment and rehabilitation plans are being maintained, and to ensure that the claim proceeds to secondary and/or tertiary levels as required.- Maintains ongoing contact with the injured person(s) and/or their family to ensure an understanding of their role in the claims process- Gathers medical information relating to the injured person's permanent impairment and forwards to the Medical Consultant for assessment.- Explains coverages, benefits, breaches of condition, exclusions, and termination of benefits to injured person(s), their families and/or other interested parties as required.- Coordinates the person’s recovery by investigating and approving funds for medical equipment and submits for approval as required. Sets up claim files, confirms coverages, establishes, and adjusts reserves and completes all necessary reporting forms and documents.- Obtains statements under oath, medical reports, and other documents to determine claims coverage.- Participates in meetings and/or interviews with SGI personnel, treating practitioners, witnesses, legal representatives and/or external persons as required.- May investigate claims arising from bodily injury resulting in death.- Contributes to program improvement meetings and will present on benefits and other rehab topics at team meetings.- Represents the interests of the Corporation at No Fault Injury Benefits mediations and recommends approval or denial.- Prepares claims for mediation, appeal, and/or action by other personnel.- Determines the possibility of subrogation, takes the appropriate action, and ensures the claim file is properly documented.- Determines replacement of customers’ articles.
High Performance Team & Culture- Supports a culture of leadership and accountability to effectively meet the key accountabilities within the scope of the role.- Displays leadership by committing to a culture of continuous learning/development of self and supports others by actively sharing knowledge, providing guidance, mentoring, training, and supporting developmental opportunities.- Demonstrates that the Health, Safety and Emergency Management Policy is applied in area of responsibility for self and others.TECHNICAL KNOWLEDGE
