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Personal Injury Rep 1
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
Location: This position may be located at any Saskatchewan branch location
Flexibility - Hybrid remote work opportunities available
GENERAL ACCOUNTABILITY
The Personal Injury Representative I is responsible for monitoring, evaluating, and coordinating benefits under No Fault Injury Benefits for less complex injury claims. The incumbent focuses on early intervention, through rehabilitation, to help injured persons return to their pre-accident status.
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 related acts and regulations.- Approves and monitors rehabilitation plans based on medical and psychosocial information obtained, and/or in consultation with treating practitioners.- Evaluates and assesses injury claims based on medical and psychosocial information and formulates benefits based on these assessments.- Gathers and analyzes employment-related information necessary to calculate Income Replacement Benefits.- Responds to questions and correspondence from the 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 plans are being maintained, and to ensure that the claim proceeds to secondary and/or tertiary levels as required.- 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 injured person's recovery by investigating need and approving funds for medical rehabilitation services and equipment and submits for approval as required.- Maintains ongoing contact with the injured person(s) and/or family to ensure an understanding of their role in the claims process.- Sets up claim files, confirms coverages, establishes, and adjusts reserves and completes all necessary reporting forms and documents.- Obtains medical information to substantiate claim by disbursing all necessary forms and documents to practitioners and/or caregivers involved.- Participates in meetings and/or interviews with SGI personnel, treating practitioners, witnesses, legal representatives and/or other external persons as required.- Participates in group meetings that focus on improving processes, may contain training elements and review of services. Recommends approval and/or denial and prepares claims for mediation, appeal and/or action by other personnel.- Identifies the possibility of subrogation, takes the appropriate action, and ensures the claim file is properly documented.- Determines replacement coverage 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 & SKILLS- Knowledge of the insurance coverages and benefits provided by the AAIA and/or general business policy wordings.- Knowledge and understanding of the terminology and treatments involved in vocational and medical rehabilitation.- Knowledge of the processes and procedures as they relate to case management and the adjustment of No-Fault claims.
EDUCATION & CERTIFICATIONS- Two-year diploma from an accredited post-secondary institution in a relevant field of study such as Social Sciences or Health, or defined equivalency.- Applicant required to enroll in and complete one Seneca course (SRC935 or SRC925) as per the Collective Bargaining Agreement.- Possess a valid operator's licence in positions where required.
EXPERIENCE- 1 - 3 years’ experience in in an insurance or customer service role in a health-related field.
BEHAVIOURAL COMPETENCIES
Leader Level 2 - Applies (Self & Others)- Accountability - Goes Beyond Bas
