Disability Claims Manager

NV-07 As a disability claims manager, you help process life and health insurance claims, promote occupational health, and manage disabilities.

You serve as a technical expert and provide discipline-specific support for your unit’s activities, initiatives, and processes. The ability to tailor your approach as needed is therefore essential. You research and analyze processes, information management and data processing.

You draw on your sound decision-making skills to solve technically complex problems and recommend ways to change or adjust methods and procedures to make them as effective and efficient as possible.

• Communicate by phone and mail with claimants, policyholders, administrators, other insurers, physicians, government pension plans, workers’ compensation boards and other stakeholders regarding claims. Document follow-up efforts.
• Process disability claims in accordance with the terms of the group insurance contract.
• Communicate with the insured and the policyholder to obtain all the information required to establish the causes and context of the absence.
• Approve and adjudicate claims for disability benefits and process waivers of premiums. Communicate its decision to the insured and the policyholder according to the defined process.
• Carry out specialized technical studies, research, and analysis. Serve as a resource person for the submission of solutions and action plans (diagnosis, intervention plan, treatment plan, return-to-work plan, disability monitoring, etc.)
• Establish an intervention plan to facilitate the insured's recovery and return to work in a timely and sustainable manner for each case of absence treated. Communicate to the insured and the policyholder the content of the intervention and return to work plans and inform the HR practitioner, if applicable, while respecting the confidential information in the file.
• Define the framework of any personalized support mandate that will be entrusted, at its discretion, to a disability management practitioner or a health professional.
• Continuously monitor the implementation of this mandate and, when necessary, make the appropriate adjustments as the situation evolves.
• Establish the amount of the benefit, determine the period payable, proceed with the payment and ensure the necessary follow-ups. Codify and enter data into the appropriate systems.
• Maintain good relations and act in partnership with external partners involved in absence management.
• Collaborate in the search for continuous improvement in relation to activities related to disability management and work in collaboration with peers.
• Prepare documents needed by the organization’s rehabilitation coordinator for claimant interviews. Review claims with medical consultants and the legal department as required.

• The work arrangement for the position is hybrid work #LI-Hybrid
• Number of jobs available : 1

• Bachelor’s degree in a related field
• A minimum of two years of relevant experience
• Customer service experience
• Experience in the health care field (an asset)

• Complete proficiency in English

Action oriented, Customer Focus, Differences, Nimble learning Communicates effectively, Decision quality, Situational adaptability 95 St-Clair Avenue West Toronto Non Syndiqué 2023-08-16 Life and health insurance (FG)