Disability Claims Administrator

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 to 1 in 3 British Columbians through employee group plans and individual plans.

We are fueled by a commitment to keep health care sustainable for all British Columbians. Through our Pacific Blue Cross 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 a permanentDisability Claims Administrator to join our Work & Wellness team. The role will be on a hybrid basis, with two days at the office, and three days from home.

**Job Summary**

**Job Duties**

**_Customer, Client and Member Services_**
- Staffs an assigned phone queue to receive, screen, respond to and redirect incoming calls from claimants and other external contacts. Escalates calls to senior staff members where required. Applies a variety of customer service tools and techniques to clarify client issues, diffuse hostility, ensure open communication and promote customer well-being.
- Provides a variety of administrative support services to claimants and other external individuals, groups, agencies and contacts including:
a. verifying claimant cheques for financial institutions;
b. verifying and activating electronic funds transfer data for claimants;
d. expediting claimant appointments for case management interventions such as independent medical examinations initiated by adjudicators including obtaining information about appointment costs, availability and length of time required for appointments; makes related travel arrangements through a third party travel service provider; distributes claimant letters with appointment details;
e. coordinating referrals to contracted external rehabilitation consultants and other third party service providers including compilation of related referral documentation;
f. requesting duplicate T4A and T5s from Finance;
g. generating and distributing group-specific payments.
- Generates graduated return to work payments for disability claims by entering offsets, issuing payments, identifying variances between employer and adjudicator payment information and following up to ensure missing information is obtained and on time claims payments are made.
- Generates reports for short term claims, issues payments and schedules new short term claim tasks in ACES.
- Provides administrative services for life waiver claims by logging claimant data including basic information, effective dates of coverage and status of claims. Follows up with third party administrator to verify and correct claimant data.

**_BC Life Claims Processing_**
- Provides a variety of administrative services related to the receipt and processing of BC Life claims by:
c. identifying variances in client ROC (Repository of Client) data and forwarding to Group Services for correction;
d. reviewing automatic payment errors and notifying adjudicators of failed autopayment;
e. issuing stop payments and requests re-issues on cheques as directed by adjudicators and for cheques issued to claims not registered in ACES.
- Reviews incoming short term disability claims to determine preliminary eligibility status of claimants by verifying accuracy and completeness of claimant and policy data on employer, employee and attending physician statements depending on claim type. Calculates tax payable using established federal tax tables. Initiates contact with individual claimants, plan administrators and employer contacts to clarify claim information such as salary hours, occupation or last day worked, and to request missing statements. Sets up and monitors task lists to ensure information is received within established turnaround times. Escalates adjudication situations to Disability Adjudications Specialists, and situations requiring indepth research or correction of system related information to Team Leader or other internal PBC departments for action.
- Follows up on long term maintenance claims to determine if claim payments are to be extended in accordance with established criteria. Distributes reinsurer and maximum benefits notifications.
- Merges short term with long term disability files when STD maximums have been reached.

**_Mail Processing_**
- Receives and researches Not In System (NIS) mail t