Senior Claims & Return-to-Work Specialist

IPEX by Aliaxis; Pineville (NC); Hybrid; USD 90,000 - 120,000; Full time

Job summary

IPEX is seeking a Senior Specialist, Claims to manage end-to-end occupational claims in a cross-border environment, ensuring compliance with U.S. and Canadian regulations.

This hybrid role is based in Pineville, NC, with potential locations in Oakville or Montreal, reporting to the Director, Health, Safety & Environment. The role liaises with employees, leaders, insurers, and regulators to optimize claim outcomes, RTW, and risk management while contributing to HSE processes.

Qualifications

• Post-secondary education in Human Resources, Occupational Health, Nursing, Kinesiology, Business Administration, or a related field.
• Disability management or claims-related certification (e.g., CDMP) is an asset.
• Bilingual in English and French.
• 3+ years of experience in occupational claims, disability/absence management, workers' compensation, or related claims function in U.S. and/or Canadian jurisdictions.
• Experience managing end-to-end claims processes, including eligibility assessment, regulatory reporting, case management, and cost monitoring.
• Strong knowledge of workers' compensation legislation, human rights and accommodation requirements, privacy legislation, and occupational health and safety standards.

Responsibilities

• Manage claims from first notice of loss through resolution, including occupational injury, disability, bodily injury, and property damage claims.
• Assess claim eligibility and submit required reports to workers' compensation boards, insurers, and regulatory bodies.
• Maintain accurate claim records, documentation, and data integrity.
• Review and reconcile claim cost statements; investigate and resolve discrepancies.
• Partner with operational leaders to support modified work, accommodations, and RTW plans.
• Liaise with workers' compensation authorities, insurers, healthcare providers, and other external stakeholders.
• Coordinate and participate in accommodation and RTW meetings to facilitate safe, timely employee reintegration.
• Monitor legislative and regulatory changes across Canada and the U.S., providing guidance on reporting, accommodation, and claims management requirements.
• Collaborate with internal legal teams and external counsel on complex claims, litigation, cost recovery, and settlements.
• Serve as a primary contact for internal and external stakeholders, ensuring timely and effective communication.
• Prepare regulatory submissions, objections, cost relief applications, internal reports, and executive summaries.
• Represent the employer in appeals and administrative proceedings, as required.
• Analyze claims data and trends to identify risk reduction and prevention opportunities.
• Contribute to the continuous improvement of HSE, incident management, and claims processes.

Education

Post-secondary education in Human Resources, Occupational Health, Nursing, Kinesiology, Business Administration, or related field

Job description

IPEX is seeking a Senior Specialist, Claims to manage end-to-end occupational claims in a cross-border environment, ensuring compliance with U.S. and Canadian regulations.

This hybrid role is based in Pineville, NC, with potential locations in Oakville or Montreal, reporting to the Director, Health, Safety & Environment. The role liaises with employees, leaders, insurers, and regulators to optimize claim outcomes, RTW, and risk management while contributing to HSE processes.