Medical Advisor, Worker's Compensation, NA

Gategroup; Mississauga; On-site; CAD 80,000 - 100,000; Full time

Job summary

A leading company in the culinary and travel sector is seeking a Workers’ Compensation Manager to oversee claims management and ensure compliance with legal standards. The role involves analyzing cases, guiding management, and collaborating with various stakeholders to promote recovery and manage costs effectively.

Qualifications

• 5 years of experience in Workers’ Compensation claims management.
• Medical certification or license in good standing required.
• At least 3 years supervisory or management experience.

Responsibilities

• Analyze reported injuries and create case management plans.
• Provide guidance on claims management strategy.
• Oversee return to work program and manage costs.

Skills

Analytical Skills

Interpersonal Skills

Problem-Solving Skills

Communication Skills

Organizational Skills

Education

Medical background (e.g., registered nurse)

Tools

MS Office

Job description

We’re looking for motivated, engaged people to help make everyone’s journeys better.

Main Duties and Responsibilities:

1. Analyze reported On the Job Injuries prior to submission to the Workers’ Compensation insurer to identify cases that require medical investigation and complex case management.
2. Create and implement investigation and case management plans for complex Workers’ Compensation claims.
3. Provide guidance and claims management strategy to Managers, Workers’ Compensation.
4. Provide guidance and legal strategy for litigated WC claims to Managers, Workers’ Compensation.
5. Review and manage medically complex cases, such as requests for modified duties or FMLA Leaves, referred by HR and managers.
6. Partner with insurance, healthcare providers, EHS, unit management, and HR to establish good working relationships and manage complex claims.
7. Provide oversight to insurance, healthcare providers, and outside counsel to ensure adherence to applicable laws, company policy, and ethical standards.
8. Oversee return to work program as a tool to promote injured workers’ recovery and manage costs.
9. Counsel managers in dealing with challenging situations and employees as they pertain to medical or return to work issues.
10. Work with HR to ensure FMLA and LOA tracking is accurate and up to date.
11. Field questions from around region, occasionally during off hours.
12. Monitor and review investigation reports and workers’ compensation folder paperwork for region.
13. Establish and maintain a systematic approach to manage transitional duty, lost time, and open claims.
14. Actively seek cost-saving measures by ensuring injured workers are treated with respect, compassion, and consistency, and through timely and aggressive claims management.
15. Collect and analyze data for use in safety and incentive programs to assist in injury reduction.
16. Ensure consistent unit compliance with company policies and procedures.
17. Monitor, review, and provide recommendations to the Corporate Risk Manager concerning reserves for claims.
18. Review the allocation charges monthly with unit managers and regional controller to explain charges, discuss potential charges for forecasting purposes, and identify possible appeals.
19. Investigate and pursue denials on claims with questionable compensability.
20. Review region’s OSHA logs monthly to ensure compliance.
21. Ensure BLS surveys and yearly OSHA logs are posted as required.
22. Ensure records are retained in compliance with local, state, and federal laws.
23. Participate in required meetings, including Incident Review Boards, Claims Reviews, Regional Meetings, PRIDE, and others upon request.
24. Participate in ongoing education to ensure current information on applicable laws, industry trends, and innovative approaches.
25. Train and assist Workers’ Compensation Supervisors and manage the daily work of direct reports.

Qualifications:

Education:

• Medical background such as registered nurse, registered practical nurse, kinesiologist, physiotherapist, etc.

Work Experience:

• 5 years of experience in Workers’ Compensation, Short-Term Disability or Long-term Disability claims management.
• Experience working with diverse populations.
• Experience working in high stress, time-sensitive environments.
• At least 3 years supervisory or management experience.

Technical Skills (Certification, Licenses, and Registration):

• Medical certification, license or registration in good standing with the appropriate governing body.
• Strong medical and appeal claims management skills.
• Solid decision-making and creative problem-solving skills.
• Ability to work calmly with individuals in highly emotional states.
• Strong interpersonal skills and ability to work in a team.
• Self-starter requiring little supervision.
• Strong analytical, organizational, and investigative skills.
• Strong verbal and written skills.
• Flexibility and responsiveness.
• Good follow-through and sense of accountability.
• Detail-oriented.
• Solid computer skills, including advanced MS Office knowledge and ability to learn claims management program.
• OSHA 10 hours certification a plus.

Language / Communication Skills:

• Excellent verbal and written communication skills.
• Strong ability to create detailed and argumentative written reports and appeal responses.
• Effective presenting and teaching abilities.
• Multilingual a plus.

Job Dimensions:

• Geographic Responsibility: N/A
• Type of Employment: Full-time
• Travel %: 30%
• Exemption Classification: Exempt

Internal Relationships: Unit management, safety team, and HR.

External Relationships: Insurance, healthcare providers, EHS.

Work Environment / Requirements of the Job: Normal office, industrial kitchen, logistics, and airport/aviation industry environment; must be able to work flexible schedules including occasional nights, holidays, and weekends.

Organization Structure:

• Direct Line Manager (Title): Dir, Workers’ Compensation & Medical Case Management, NA

The above statements are intended to describe the general nature and level of work being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. Management reserves the right to modify, add, or remove duties and to assign other duties as necessary. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

gategroup is an equal opportunity employer committed to workforce diversity. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, or other category under applicable law.

For further information regarding Equal Employment Opportunity, copy and paste the following URL into your web browser: http://www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf

If you want to be part of a team that helps make travel and culinary memories, join us!