Complex Group Claims Specialist

Complex Group Claims Specialist

Reporting to: Director, Operations

Comma Recruitment are looking for a Claims Specialist to manage complex disability claims in a pro-active manner with the goal of achieving a level of functional improvement that supports the earliest possible return to employability.

This involves working directly with a claimant as well as their employer, physician and treatment providers to achieve the required level of functional improvement to support the employability goal. A Rehabilitation Consultant assesses the vocational, educational and rehabilitative needs of claimants who are disabled in order to understand the functional impact of the diagnosis.

The Claims Specialist then develops, implements and progresses approved rehabilitation service delivery plans based on claimant needs and contractual provisions. Also, they research and secure external treatment providers if needed to achieve functional improvement towards the employability goal.

Accountabilities:

• Assess the potential for rehabilitation services to impact on the duration of disability of complex claims through file review as well as telephone and/or face to face interview of claimants, employers and involved treatment providers.
• Develop realistic, cost-effective rehabilitation/ return to work plans for actions focusing on return to work.
• Provide counseling and/or referral services as necessary regarding identified needs of claimants. (disability adjustment factors; treatment; vocational solutions; community resources etc.)
• Maintain follow up contact with a claimant, focusing on barrier resolution and functional improvements made, while providing claimant support during the intervention period.
• Manage return to employability expectations with employees, employers and care providers
• Prepare written reports detailing findings and recommendations.
• Track rehabilitation activities and document case files electronically.

 

As an integral member of the Group Disability Claims, the Claims Specialist works closely with the Sr. Disability Claim Case Managers to ensure that opportunities for non-litigated settlements are appropriately identified and move through the process in a timely way and in a qualitative manner until case is resolved by either offer not being made, offer made but not accepted and/or approved or offer accepted with plan sponsor approval.

Additional Role Specific Accountabilities:

• Complete, print, and send settlement offers, includes choosing appropriate accompanying documents based on type of case;
• Communicate with plan sponsors, plan members, lawyers, physicians and other departments by electronic mail, telephone, and written correspondence;
• Update information on imaging and other computer systems, including databases;
• Ensure any impact of procedural changes is resolved to ensure successful transition to new processes;
• Document and maintain training modules, tools and materials;
• Provide technical assistance for internal inquiries;
• Conduct audits on a monthly basis relevant to potential rehabilitation and settlement cases

 

Competencies:

• Excellent communication skills;
• Strong analytical skills, excellent problem solving ability, can work in a very organized manner handling multiple tasks and prioritizing work with a minimum of supervision;
• Must have a positive attitude, a commitment to quality service and be able to cope with the demands of the role, including tight deadlines and high work volumes;
• Strong PC and keyboarding skills;
• Attention to detail is important;
• Adaptability and flexibility are key to success in this role;
• Strong team player;
• Business and professional integrity and ethics;
• Committed to learning and continuous improvement;
• Solid relevant product knowledge
• A degree in a discipline related to vocational rehabilitation counseling, with experience in health or social sciences preferred.
• 5-7 years group claims/rehab experience preferred.

We offer a challenging, team-oriented work environment, competitive income and benefits, and opportunities for professional and personal development and growth.

Please forward resume to [email protected]