Payment Specialist

Workplace Safety and Insurance Board (WSIB); Toronto; On-site; CAD 50,000 - 70,000; Full time

Job summary

A provincial insurance board in Toronto is looking for a Claims Analyst to review and process wage replacement claims. The ideal candidate must have a strong background in financial concepts and experience in benefit payment processing. Responsibilities include ensuring claim accuracy, communicating with parties involved, and making adjustments to payments as necessary. This position promotes an inclusive work environment, valuing diversity among its employees.

Qualifications

• High school completion and a certificate program of up to one year in accounting, bookkeeping, payroll, mathematics or finance.
• 1 year prior experience in financial/mathematical concepts is necessary.

Responsibilities

• Review and analyze claims for benefits payment.
• Validate benefit payment authorizations and process claims.
• Communicate with workplace parties and case owners for required information.
• Calculate wage replacement benefits and make necessary adjustments.

Skills

Financial/mathematical concepts

Benefit payment processing

Communication

Attention to detail

Education

High school completion

Certificate in accounting or finance

Job description

Job Summary :

As a member of a provincial team, review and critically analyze claims that have been approved for the payment or adjustment of wage replacement and related benefits, leveraging knowledge of legislation, operational policies and guidelines to determine, calculate and process the benefits in a timely and accurate manner. This includes contacting Workplace Parties and Case Owners to request and/or clarify necessary earnings information. Provide support to Case Owners and Workplace Parties in addressing or interpreting complex benefit decisions and their outcomes. Responsible to determine the appropriateness of a Long-Term Rate (LTR) recalculation of wage replacement benefits in accordance with Operational Policy, requesting and assessing earnings information from Workplace Parties, calculating rate of benefits, communicating decisions and reconsidering any related objections.

Major Duties and Responsibilities

1. Validate the accuracy of benefit payment authorizations received from Case Owners and in cases determined by eAdjudication; take action including determining the earnings basis according to current and previous applicable legislation and operational policies before processing payments in various WSIB systems.
2. Contacting workplace parties to obtain and verify information including earnings information, lost time, modified duties, and document other employer questions/concerns. Refer to decision makers to review. Document information to complete earnings calculations, process LOE benefits for the correct period, per e-Adjudication guidelines.
3. Ensure the claim is directed to the proper operations area and assign necessary administrative activities based on the appropriate RTW scenario as outlined in the e-Adjudication payment process.
4. Identify, investigate, analyze, and cross reference related documentation in the claim file to determine if information is sufficient prior to processing the payment.
5. Contact workplace parties (WPPs) and/or Case Owner to obtain or clarify required information regarding earnings or return to work information; determine and set a suitable temporary rate and request further earnings information required to adjust temporary rate when established by the Payment Specialist.
6. Confer with Case Owners to determine appropriate action with respect to payments; return file to Case Owners for further action including a detailed memo explaining the information or action required.
7. Consult with the manager for complex payment problems such as removal of interest charges for accident cost, manual and demand cheques, unusual payments and complex system workarounds.
8. Determine cases that require a recalculation of wage replacement benefits to a long-term rate (LTR) and determine the employment pattern of the injured person to ensure correct earnings are requested for the LTR calculation.
9. Follow up to identify and request necessary earnings information in writing from the WPPs for the recalculation and implementation of the LTR, if applicable. LTR recalculation decisions are communicated in writing to WPPs and representatives.
10. Reconsider LTR decisions and short-term rate calculations in response to additional earnings information or objections from WPPs, process adjustments and prepare related documentation and communication of decisions to WPPs; where required, work with Case Owners to prepare the claim for referral to the Appeals Branch.
11. Calculate, communicate, prorate and ensure funds are directed to appropriate payees such as accident employers, HRSDC, Social Services, court orders, Canada Revenue Agency requirements to pay garnishments, third party insurers, and other employers.
12. Calculate and process Pre-90 Pension / Supplements (OAS and Bill 165) / TT and Bill 162 benefits, apply system workarounds and ensure accurate interpretation and implementation of WSIA decisions with regards to wage replacement and related benefits.
13. Process NEL benefits and related accident cost adjustments.
14. Process and adjust Survivor benefits such as Burial cost reimbursements, Lump Sum benefits and ongoing support benefits.
15. Complete LRI reconciliations and adjustments (if necessary) as requested by the LRI Department.
16. Manually calculate the rate of compensation to align with system parameter calculations, excess interest, minimum and maximum payouts, escalation criteria in Pre-Bill 101 claims, and applicable policies, rules and regulations.
17. Create payment transactions and adjustments and document required information for all entitlement authorizations, including exercising delegation of authority to self-release payments up to $29,999.99 for each file; take corrective action in cases of inaccurate transactions including communicating to the necessary departments.
18. Work with management to review daily, weekly, monthly, quarterly and yearly system reports that show cheque errors, manual cheque lists, indexing errors, and ensure the accuracy of payments is maintained.
19. Clarify missing or unclear direction from garnishment administrator on garnishment of benefits.
20. Notify Treasury of requests to pull and cancel cheques and apply credits to accident cost for manual transactions.
21. Cancel, place stop-payment, reissue of cheque/direct deposit that are returned, outstanding, purged, or void. Use PRCM function (High Risk screen) to reissue stale-dated cheques or create appropriate overpayments.
22. Update the worker/payee profile with relevant details (date of accident, date of birth, date of death, gender where required).
23. Promote the use of e-services and online services.
24. May be required to engage with management on identifying gaps in training, process or policies to help drive improvement.

Job Requirements

Education

• High school completion and a certificate program of up to one year in accounting, bookkeeping, payroll, mathematics or finance.

Experience

• Total of four years and two months experience. One year prior experience in financial/mathematical concepts.

Our commitment to equity, diversity and inclusion

We respect and value the diversity of our people. We strive to create an environment where employees can be themselves and where our differences are celebrated.

The WSIB is committed to being accessible and inclusive, and following barrier-free and accessible employment practices in compliance with the Accessibility for Ontarians with Disabilities Act (AODA). Should you require accommodation through any stage of the recruitment process, please let us know when we contact you and we will work with you to meet your needs.