Disability Management Specialist

People Corporation; Burlington; On-site; CAD 60,000 - 67,000; Full time

Benefits offered by this job

Extended health care and dental

Retirement savings plan with companya

Health & Wellness offerings

Mental Health programs and support

Industry designation assistance

Job summary

Organizational Solutions Inc. (OSI) is seeking a Disability Management Specialist to oversee the full lifecycle of disability management claims, including complex files.

You will assess function, review medical/workplace documentation, adjudicate claims, and initiate RTW planning in collaboration with healthcare providers, clients, and partners. The role emphasizes thorough documentation in the Internal Claims Management System and delivering early and safe RTW outcomes with individualized

Qualifications

• Experience in disability management, claims adjudication and RTW initiatives.
• Knowledge of STD/LTD claims management and related processes.
• Understanding of medical terminology and workplace health concepts.

Responsibilities

• Manage all non-complex and complex disability claims with focus on return-to-work.
• Conduct detailed phone functional interviews regarding activities of daily living.
• Adjudicate claims per client and OSI policies with high accuracy.
• Develop and monitor individualized recovery and transitional RTW plans.
• Communicate claim status and next steps clearly to clients and claimants.

Skills

Disability management

Claims adjudication

Return-to-work

STD/LTD claims

Microsoft Office

Internal claims system

Bilingual FR/EN

Education

Professional designation in disability management

Healthcare background (RN/RPN/Kin./RRP)

Tools

Microsoft Office

Internal database system

Job description

We are seeking a Disability Management Specialist to join our Organizational Solutions team (OSI).The Disability Management Specialist is responsible for overseeing the full lifecycle of disability management claims including complex files. You will conduct a detailed functional assessment, review medical and workplace documentation, adjudicate claims in accordance with organizational and client policies, and initial consideration of the return to work on every claim.Additionally, you will maintain accurate and timely documentation within the Internal Claims Management System, along with ensuring all claim activities, communication, and next steps are clearly documented and communicated to the client.The Disability Management Specialist will ensure early and safe return to work through the development and monitoring of individualized recovery and transitional return to work plans. This includes collaborating with healthcare providers, other key support service partners and health providers, and employers (clients), to optimize treatment and workplace accommodations.The Disability Management Specialist will also provide guidance and support to other Recovery Facilitators by sharing expertise, assisting with complex claim decisions, and promoting consistency in client-specific processes and protocols.The Disability Management Specialist will:Manage all non-complex and complex claims including but not limited to psychological claims, multiple diagnosis, and co-morbid conditionsConduct detailed phone functional interviews regarding activities of daily living (ADL) while providing tips to reduce barriersEvaluate medical and workplace information to determine if key elements are presentAdjudicate of all claims in accordance with client and OSI policies, and with a high degree of excellenceRequest clinical notes in any claim that requires additional clarity including, mental health claims with pre-existing documentation, identified workplace concerns, unique circumstances, etc.Enter detailed info regarding the claim, status, communications, and next steps, into the Internal Claims Management SystemEnsure a Care Management Action Plan is in place on all files, as requiredManage all claims with a return to work (RTW) focus and for the lowest duration possible and with a continuous improvement impactProduce appropriate tools to communicate status of claim to clients and claimants (varies based on client)Develop outcome focused recovery and return to work plans with facilitation of return to work as soon as possibleDetermine when additional tools are to be used at the appropriate times (i.e.: IME / FCE, refer to rehabilitation, medical consultant, pharmacogenetics, cognability, or workstation evaluations etc.)Interact with various key support service partners, health providers, to enhance claim outcomes, facilitate treatment plans, and ensure the claimant is receiving optimal treatment at all timesBe aware of status on claims at all times, ensuring Internal Claims Management System is fully updatedCommunicate the employee’s functional capabilities to the employer to determine if the employer is able to provide modified duties in the return to work planningFacilitate return to work consistently with a Transitional Return to Work Plans (TRTWP)Monitor the progressive Transitional Return to Work PlansFollow up with any missing claim actions or informationComplete file reviews with Team Lead on any claims over 30 daysComplete midpoint review with designated team membersEnsure reported comments updated within the designated time frameClose claim in the Internal Claims Management System once claimant has returned to workAct as the primary contact on assigned adhoc claimsRecord all billable and non-billable time in the Internal Claims ManagementWork with client(s) to understand workplace philosophy and job demandsParticipate in monthly client calls and meetings as requiredUpdate any monthly reports, as requiredWork collaboratively as part of client(s) team both internally and externallyCoach and mentor other disability management staff by enhancing their knowledge and education levelsProvide support to other Recovery Facilitators and guidance on client(s) specifics and decision process and protocolTo be Successful as the Disability Management Specialist, you will need:The ability to plan – set objectives and determine strategy to achieve themA strong sense of urgency and organization / prioritization skillsTo identify problems and develop effective solutions quicklyTo work with great accuracy and attention to detailCritical thinking skills, analytical reasoning, strong negotiation skills and conflict resolution skillsExcellent customer service and communication skillsThe ability to work within set procedures and policies to ensure the privacy protocols and standard operating procedures are adhered to at all timesThe ability to meet and exceed all Key Performance Metrics (KPM)To uphold a strict level of confidentialityExcellent emotional intelligence and the ability to appreciate different levels of experience providing appropriate supportA healthy view and understanding of mental healthAll Star Candidates will have:Relevant experience in Disability Management / Claims Adjudication / Return-To-Work Initiatives / STD and LTD Claims ManagementKnowledge and understanding of short-term, or long-term disability programs, various treatment programs, and return to work planning and initiativesUnderstanding of medical terminology, and common physical and mental health conditionsA registered professional designation / certification or working towards is an asset: (RN, RPN, Kin., RRP or other related healthcare background; Certified Disability Management Practitioner / Certified Return to Work CoordinatorStrong proficiency in Microsoft Office and have the ability to learn an internal database systemBilingual proficiency in both French and English, including strong written and verbal communication skills, would be considered an asset.What's in it for you:Learn by working alongside our expertsExtended health care and dental benefitsA retirement savings plan with company contributionsA suite of Health & Wellness offeringsMental Health programs and support for you and your familyAssistance for the completion of industry designationsCompetitive compensationOrganizational Solutions Inc. (OSI) is dedicated to providing exceptional disability management services tailored to the unique needs of organizations across Canada.We are committed to providing an inclusive, accessible environment, where all employees and clients feel valued, respected, and supported. We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee has the opportunity to reach their potential. If you require an accommodation or an alternative format of any posting please reach out to [e-mail] .The base salary for this position is between $60,000 - $67,000 annually.This represents base salary only and does not represent other variable compensation components of our total compensation (i.e. annual bonus, commission). The actual base salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. If you are selected to move forward in our recruitment process, the Talent Acquisition Specialist will be able to provide additional details of the total compensation for this role.