Adjudicator

Job Summary (external):

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Adjudicators play a pivotal role in the claims process, often serving as the initial point of contact for workers and employers during sensitive circumstances. They are tasked with creating a positive first impression by acknowledging reported injuries and gathering pertinent information necessary to make timely and well-communicated decisions. Through telephone and written correspondence, Adjudicators determine eligibility for compensation benefits and services, ensuring decisions are consistent with established policies and legislation.

We are seeking service-oriented, proactive, and results-driven professionals capable of thriving in a fast-paced environment. Utilizing a proactive claims management approach, Adjudicators make and communicate eligibility decisions promptly and consistently. They provide essential information to internal and external stakeholders regarding recovery and return-to-work processes, addressing the needs of workers and employers by actively listening, collecting and conveying relevant information, and clarifying rights, responsibilities, and obligations.

Job Duties:

Determines which claims are acceptable and authorizes/denies entitlement to compensation on an ongoing basis; communicates the decision and rationale to injured workers, employers, representatives, and healthcare practitioners.

Gathers, assembles, reviews, develops, and assesses information and opinions through written correspondence, in-person meetings, and telephone to establish initial and ongoing entitlement to compensation.

Communicates with injured workers, employers, representatives, healthcare practitioners, witnesses, and other involved parties to obtain/provide information, respond to enquiries and explain decisions, in writing or verbally.

Gathers appropriate wage information and provides direction to Payment Assessors re: payment of a claim and duration.

Identifies claims where a pre-existing condition exists, establishes entitlement accordingly, and authorizes or denies cost relief to employers.

Manages and facilitates the overall claim process (ie. assessing, planning, implementing, coordinating, monitoring, evaluating and terminating) including Time Loss claims up to 8 weeks duration; Medical Treatment claims up to 14 weeks; Occupational Disease claims up to 8 weeks and Hearing Loss claims for the duration of the claim.

Acts as a primary contact for injured workers, employers, representatives, healthcare practitioners, and specialized service providers to ensure the coordinated management of claims through the recovery and return to work processes or other resolutions.

Facilities established protocols for potential stress/crisis situations including involvement with the Special Services Unit.

Implements Chiropractic and Physiotherapy Protocol by identifying the appropriate category and coverage period and notifies all parties in writing. Monitors no time loss claims involving physiotherapy or chiropractic treatment for up to 14 weeks from date of injury. Manages noise induced hearing loss claims for the entire duration of the claim.

Adjudicates Fatality claims and determines spousal and dependent's entitlement on fatality claims and refers files to appropriate internal resources for ongoing management.

Delivers presentations or attends information/discussion sessions on behalf of the WCB with external stakeholders.

Provides service both independently, or in consultation with internal/external service providers, to injured workers by assessing and facilitating return to work on an individual basis. This includes development of a strategy to bring each claim to resolution.

Promotes and supports workplace-based disability management programs.

Initiates recovery of overpayments within guidelines.

Authorizes medical aid expenditures on files up to $25,000 and lump sum benefits related to fatalities up to $75,000 (spousal benefits) and makes recommendations of payments beyond their authorization limit to the Supervisor/Manager/Director.

Identifies claims where cost allocation/relief is appropriate per legislation and policy.

Gathers/assembles information requested, implements decisions and reviews information received from senior staff, the Review Office, Medical Review Panel, and Appeal Panel.

Ensures proper recording of claims involving inter-provincial and third party, as well as coding of all occupational disease claims.

Identifies and recommends improvements in service or system/policy changes related to adjudication and case management.

Performs other related duties as assigned.

Qualifications:

Completion of a two (2) year diploma in a related discipline and a minimum three (3) years' experience in a similar environment making entitlement decisions based on a defined set of criteria (ie. policies, procedures, legislation, etc.) including client service, or an equivalent combination of education and/or experience

Proficiency in the use of personal computers and software in a Windows environment

Ability to obtain, assess and evaluate information to support claims decisions

Ability to interpret and apply provisions, policies, procedures and legislation

Ability to communicate effectively, both verbally and in writing

Ability to deliver presentations to external clients

Ability to work under pressure to tight deadlines while providing excellent client service in sometimes confrontational and sensitive situations

Ability to organize prioritize and prioritize workload

Ability to work independently and as part of a team

Knowledge of adjudicative, disability management, vocational rehabilitation, case management and workplace-based programs, policies, procedures and principles would be an asset

Knowledge of medical terminology/issues would be an asset

Ability to communicate proficiently in both official languages (English & French) is an asset, but is not required

Competencies (internal only):

Essential:

Client Service Orientation

Judgment/Problem Solving

Analysis/Problem Assessment

Planning, Organizing and Follow Up

Very Important:

Communication - Written and Verbal

Important:

Teamwork

Persuasiveness

Impact

Additional Information (internal):

Up to 8 Permanent Positions

Developmental opportunities for those who do not meet the qualifications or are unsuccessful in the interview process may be available.

Successful applicants will be placed on a 6-month eligibility list that will be used to staff all permanent and term vacancies over this period. If you are on an existing eligibility list for this position, you will need to re-apply to be eligible for this new eligibility list.

You may be asked to demonstrate your ability through competency based interviewing and/or testing.

Screening decisions are based on information outlined in your resumé and cover letter. Your work performance must be satisfactory for your application to be considered. If applying for a term position or out of a term position, please note that article 10.09d of the Collective Agreement may apply.

Please note that this position is expected to begin in January 2026 with a 10 week training class. Hours of work during the training period are 8:30 a.m.-4:30 p.m. Participation in Compressed Work Week, Additional Day Off (ADO), or a Flexible Work Hours schedule will be suspended during a training class and no extended vacation time will be permitted.

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 are or may be disabled by one or more barriers in the workplace. Accommodations are available on request for candidates taking part in all aspects of the selection process.

Additional Information (external):

Work With Us Video

Up to 8 Permanent Positions

Annual Salary Range: $66,438 - $85,536

Start Date: January 2026

Formal Classroom Training Period: 10 weeks (Monday – Friday, 8:30 a.m. – 4:30 p.m.).

A criminal record check and education verification will be required for the successful candidate.

The WCB is committed to building a skilled, diverse workforce with equitable representation of Indigenous persons, visible minorities, persons with disabilities, women, 2SLGBTQ+ 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 are or may be disabled by one or more barriers in the workplace. Accommodations are available on request for candidates taking part in all aspects of the selection process.

Job Summary (internal):

The Adjudicator is responsible for adjudicating and managing Time Loss claims up to 8 weeks duration; Medical Treatment claims up to 14 weeks; Occupational Disease claims up to 8 weeks and Hearing Loss claims for the duration of the claim. As well, they are responsible for adjudicating Fatality claims.