- Manage all non-complex and complex claims including but not limited to psychological claims, multiple diagnosis, and co-morbid conditions
- Conduct detailed phone functional interviews regarding activities of daily living (ADL) while providing tips to reduce barriers
- Evaluate medical and workplace information to determine if key elements are present
- Adjudicate all claims in accordance with client and OSI policies, and with a high degree of excellence
- Request 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 System
- Ensure a Care Management Action Plan is in place on all files, as required
- Manage all claims with a return to work (RTW) focus and for the lowest duration possible and with a continuous improvement impact
- Produce appropriate tools to communicate status of claim to clients and claimants (varies based on client)
Requirements
- Bilingual in French and English including both written and oral
- Relevant experience in Disability Management / Claims Adjudication / Return-To-Work Initiatives / STD and LTD Claims Management
- Knowledge and understanding of short-term, or long-term disability programs, various treatment programs, and return to work planning and initiatives
- Understanding of medical terminology, and common physical and mental health conditions
- A registered skilled 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 Coordinator
- Strong proficiency in Microsoft Office and have the ability to learn an internal database system.
Core Competencies
Demonstrates expertise in managing complex claims, including psychological and co-morbid conditions, while ensuring compliance with client and OSI policies. Proficient in conducting functional interviews and developing Care Management Action Plans to facilitate effective return-to-work initiatives.
Highest-signal resume keywords
- Disability Management
- Claims Adjudication
- Return-To-Work Initiatives
- Bilingual in French and English
- Microsoft Office Proficiency
ATS Optimization Keywords
Hard Skills
- Claims Management
- Medical Terminology
- Functional Interviews
- Return to Work Planning
- Short-Term Disability Programs
- Long-Term Disability Programs
- Co-Morbid Conditions
- Psychological Claims
- Adjudication
- Care Management Action Plan
Certifications & Qualifications
- Registered Nurse (RN)
- Registered Practical Nurse (RPN)
- Kinesiologist (Kin)
- Registered Rehabilitation Professional (RRP)
- Certified Disability Management Practitioner
- Certified Return to Work Coordinator
Industry Keywords
- Disability Management
- Claims Adjudication
- Return to Work Initiatives
- STD Claims Management
- LTD Claims Management
- Mental Health Conditions
- Physical Health Conditions
Tools & Technologies
- Internal Claims Management System
- Microsoft Office