We are an independent, not-for-profit society with strong roots in BC’s health care system. We provide health, dental, life, disability, and travel coverage to 1 in 3 British Columbians through employee group plans and individual plans. We are fueled by a commitment to keep health care sustainable for all British Columbians.

Through our PBC Health Foundation, we fund projects that improve health outcomes directly related to mental health and wellbeing as well as the prevention and/or management of chronic disease. Work-life balance with flexible working hours of 7 hours per day, Monday to Friday (i.e., Paid vacation starts at 3 weeks per year, and increases with years of service. a combination of work from office and work from home days). Generous benefits, including extended health, dental, and life insurance; Company pension contributions after 1 year of service.

Onsite gym, cafeteria, and access to virtual doctors/counsellors 24/7 via our Employee Family Assistance Program! We are searching for 2 Permanent Disability Claims Specialist to join our Work and Wellness department. This position is unionized and part of the CUPE 1816 Bargaining Unit.

This position is paid at hourly rates and receives wage increases in accordance with the Collective Agreement. Under the general supervision of the Supervisor, Work and Wellness (W&W;), the Disability Claims Specialist provides professional disability claims services to clients and applicants including reviewing, analyzing, and investigating claims information from a variety of sources, determining adjudication and assessment actions required to process short-term disability claims and initiating referrals or escalation to other internal or external disability resources where intervention or case management is required. This position prepares and presents pending short-term disability claims and related recommendations to the disability team for discussion and review.

This position monitors and updates active claims on an ongoing basis and communicates claims-related decisions directly to clients and applicants. This position generates payments for authorized short-term disability claims.



Work & Wellness Disability Claims Adjudication and Assessment Provides Professional Disability Claims Services To Clients And Applicants Undergoing Review To Ensure Claims Are Coordinated Within Contractual Terms And Conditions Of Eligibility And Coverage By reviewing, analyzing, and investigating claims and history/conditions of claimants to determine eligibility information from a variety of sources as well as requesting and documenting additional information as required. interpreting and applying contract wording, medical documentation, claims policies and procedures, statutory requirements and other guidelines affecting valuation and disposition of short-term disability claims. initiating regular telephone contact with claimants, policy-holders, employers, doctors, lawyers, brokers, third parties and other stakeholders in the disability claims process to gather additional information, including the application of appropriate questioning techniques to obtain information determining level of functioning, determining status of accommodation, and return-to-work options. planning the content of and composing a variety of written correspondence and documents which adhere to the established standards of business communications and internal style guidelines. adjudicating claims including keying claims data into claims processing systems, documenting all contacts made and actions taken, processing payments, providing claim updates, and maintaining files.

Referring claims to other internal or external disability stakeholders where intervention or case management is required. acting as liaison with Finance on third party claims to ensure overpayments are identified and followed up, or on an occasional basis, manually calculating amounts owing based on policy provisions. communicates recovery amounts and expectations for repayment to all affected parties, and follows up to ensure collection.



Prepares and presents pending short term disability claims and related recommendations to the disability team for discussion and review. Supports findings and justifies acceptance or denial of claim, including presentation of options for more complex and/or subjective conditions and considerations.

Monitors and updates claims on a continual basis, identifies impact of changing conditions or unforeseen circumstances and determines required actions including recommending suspension of advantages. Communicates claims-related decisions directly to clients and applicants, and composes written correspondence containing details of decisions including reasons for denial. verifying salary and setting up tax and other applicable deductions. entering claimant notes for inclusion on the Explanation of Benefits (EOB). setting up auto payments for approved future payment dates. making payment adjustments in accordance with policy. communicating with stakeholders to update their information and the claim as required. Customer, Client, and Member Service Consistent with Work & Wellness’s service level objectives, responds to a variety of general inquiries by phone and email to maintain client relationships and client retention.

Maintains up-to-date knowledge of disability management practices, policies and procedures, system requirements and other information related to the provision of disability management services through continuous learning initiatives. Performs other assigned duties related to the provision of disability claims, adjudication and administrative support services which do not affect the rating of the job. High school graduation, or equivalent. ~ Completion of a 1-year Disability Management Diploma (288 hours), or equivalent. ~ Demonstrated proficiency in basic Word and Excel. ~ Typing skills of 40 wpm. ~2 years of previous related experience, including 1 year in a Disability Claims Administrator, W&W; or Benefit Representative, EHC/Dental positions, or equivalent. ~ Diversity, Equity, and Inclusion PBC is an Indigenous Works employer of choice, an Insurance Business Canada Diversity, Equity, and Inclusion award winner, one of Canada’s Greenest employers, a Canadian Centre for Diversity and Inclusion (CCDI) employer partner, and a Pride at Work partner.

📌 Specialist, Virtual Health (Vancouver)
🏢 Pacific Blue Cross
📍 Vancouver