Claims Management Specialist

Ross Memorial Hospital (RMH) is an active, acute-care community hospital located in the heart of the City of Kawartha Lakes. Among our acute and continuing care services, our team cares for 45,000 patients per year in the 24/7/365 emergency department, provides orthopedics and ophthalmology, operates a dialysis unit, and is renowned for its mental health programs and restorative seniors care. The Ross family takes pride in providing compassionate, quality patient care.

**Position Summary**

The Claims Management Specialist will be responsible for all aspects of managing employee Absenteeism, Short and Long Term Disability, Workplace Safety Insurance Board Claims (WSIB), Return to Work and Modified Work duties. Ensuring legislative compliance with the focus on early intervention on lost time and attendance related claims and supporting the hospital’s Attendance Monitoring Program and Directors/Managers on absenteeism claims, return to work and modified work duties are major responsibilities of this position. The position is also responsible to support Haliburton Highlands Health Services (HHHS) with claims management services for complex Short and Long Term Disability, Workplace Safety Insurance Board Claims up to 7.5 hours per week.

Leads or participates in hospital committees as required and plays a key role in employee relations within the hospital and acts as a mediator in resolving workplace conflict. Conducts investigations and provides recommendations as to appropriate disciplinary action when warranted.

The Claims Management Specialist will be expected to model the Ross Memorial Hospital philosophy and values by communicating effectively, maintaining positive relations with management, employees, external agencies and support team members to effectively resolving issues and concerns. The individual will strive to build employee confidence and protect confidential and sensitive employee information, as with all Human Resource business activity.

Effective date: As soon as possible

MAJOR DUTIES AND RESPONSIBILITIES:

- Works closely with Human Resources staff, hospital managers, employees, physicians and union representatives as well as related professional agencies and external agencies.
- Maintains an information collection database to support the reporting and statistical needs of the organization as required, in terms of trends in attendance, injury, lost time, cost and risk analysis, etc.
- Responsible for managing Accommodation requests related to WSIB, temporary or permanent impairments of any nature.
- Membership and participation on pertinent hospital committees such as JHSC, compliance review, and process development. Maintaining skills and knowledge by attending relevant educational sessions and staying informed on Human Resource policies and procedures is a requisite. Staying abreast of current labour trends and legal decisions is key to advising management on how to manage employee issues to ensure mínimal liability to the hospital.
- Responsible for the Absenteeism Monitoring program within the hospital and ensures ongoing development and maintenance of the program to reduce costs and ensure consistent practices with regard to dealing with employees who have been identified and enrolled in the Attendance Monitoring program.
- Provides advice and guidance to management with regard to employee relations and complaints. Maintain a professional, unbiased position when investigating such incidents and provide recommendations as to the outcome and actions required.
- Provides day to day advice and guidance to management with regard to the interpretation of the Collective Agreements and other relevant legislation, arbitrations and court decisions (i.e.: WSIA, ESA 2000., Labour Relations Act, Occupational Health & Safety Act, Human Rights Code of Ontario, etc.)
- Minimizes risks to self, other staff, patients and visitors through:
a) familiarity with policies and procedures regarding safety
b) attendance at safety training programs including fire safety, back care and WHMIS training
c) prompt reporting of hazards and incidents

Note: Occasional travel to Haliburton may be required.

**Essential Qualifications**
- Degree in Health discipline or Human Resources or related field and/ or equal experience in Nursing/HR/Business Management Role. In addition, Certificate in Human Resources (C.H.R.P.), Disability or W.S.I.B. Claims Management. Special consideration for those with Kinesiology or Nursing background
- Minimum of five (5) years work experience in either an industrial or healthcare facility
- Demonstrated knowledge of relevant legislations such as Workplace Safety and Insurance Act, Privacy Legislation Standards, Occupational Health and Safety Act, Employment Standards Act, Labour Relations Act, Human Rights Code of Ontario, etc.
- Excellent interpersonal skills, and the ability to work effectively with staff, physicians and external agencies such as the WSIB and insurance carriers
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