ELIGIBILITY ADJUDICATOR | [OCF-441]

ELIGIBILITY ADJUDICATOR | [OCF-441]

17 Nov
|
Workplace Safety and Insurance Board
|
Toronto

17 Nov

Workplace Safety and Insurance Board

Toronto

WSIB offices remain closed due to COVID-19. Our priority is the health and wellness of employees and the people of Ontario. As such, this position may involve working from home, within Ontario, for all or part of the duration of this position.



About the Workplace Safety and Insurance Board (WSIB)



We're here to help. When an injury or illness happens on the job, we move quickly to provide wage-loss benefits, medical coverage and support to help people get back to work. Funded by businesses, we also provide no-fault collective liability insurance and access to industry-specific health and safety information.

We are one of the largest insurance organizations in North America covering over five million people in more than 300,000 workplaces across Ontario. For more information, visit wsib.ca.



At the WSIB, you'll have the opportunity to:



- explore many career paths and follow your passion

- continuously learn and grow professionally

- be recognized for the great work you do

- participate in programs that support your health and wellbeing



You'll also receive a competitive salary, along with a comprehensive benefit package and defined benefit pension plan.



The WSIB is recruiting for current and future unilingual and bilingual (French speaking) opportunities in the following locations:



Guelph, Hamilton, Kingston, Kitchener, London, North Bay, Ottawa, Windsor, Sault Ste. Marie, Sudbury, Thunder Bay, Toronto, Timmins & Windsor



There may be a requirement to work 9:15am to 5:15pm



Salary Grade: 211 From: $73,559.14 To: $88,778.98



What can I expect to do in this role?



Use a proactive case management approach to make and communicate eligibility decision on benefits and services in a timely fashion that are consistent with relevant WSIB policy. Address worker and employer needs by actively listening, collecting and proving relevant information, and helping the workplace parties understand their rights, responsibilities and obligations.

Manage cases that are allowed, denied, reconsidered or resolved within established program guidelines, following a structured case management framework to enable them to achieve high quality eligibility decisions and successful outcomes.



How do I qualify?



Major Responsibilities:



1. Inform parties of their rights, responsibilities and obligations under the WSI Act and applicable legislation, and the consequences of non-compliance.

2. Proactively collect information from workplace parties and healthcare providers required for eligibility decisions and respond to inquiries.

3. Assess case and plan towards best outcomes. Make eligibility decisions quickly and accurately and communicate them, verbally and in writing by determining the following:



- The employer is covered under the Act;

- The worker is employed by the employer at the time of the injury;

- The injury is work-related;

- Proof of accident can be established;

- The diagnosis is compatible with the accident;

- Continuity and compatibility support ongoing entitlement in the case of recurrence;

- Ensuring accident reporting compliance with the employer.



4. Support workplace parties in their return to work (RTW) efforts by sharing any available information about the workers' capabilities and/or precautions.

5. With the assistance of Payment Specialists where required, ensure appropriate earnings information is on file in order to determine the appropriate duration and level of benefits.

6. Review and monitor cases until closure or transition to a Case Manager, assessing RTW and recovery factors to differentiate cases requiring Case Manager expertise.

7. Refer requests to appropriate internal WSIB parties (Nurse Consultant, Account Specialist, Legal Services) to gain their expertise on various components of a claim when the need for appropriate intervention is recognized and follow up with them as required.

8. Attempt to prevent or resolve disputes, handle requests for reconsideration and, if unresolved, arrange access and process the objection.

9. Perform other related duties as assigned or required such as participation in the development and implementation of business plans and projects.



Job Requirements:



Job Requirements:

Education



- University completion at undergraduate level.



Experience



- Two years prior experience in adjudication and customer service.



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.



Disclosing conflicts of interest



As public servants, employees at the WSIB have a responsibility to act in an ethical way at all times to create a respectful workplace and maintain public trust. Job applicants are required to disclose any circumstance that could result in a real, potential or perceived conflict of interest. A conflict of interest is any situation where your private interests may impair or be perceived to impair the decisions you make in your official capacity. This may include: political activity, directorship, other outside employment and certain personal relationships (e.g. with current WSIB employees, customers and/or stakeholders). If you have any questions about conflict of interest obligations and/or how to make a disclosure, please contact the Talent Acquisition Centre at [email protected]



Privacy information:



We collect personal information from your resume, application, cover letter and references under the authority of the Workplace Safety and Insurance Act, 1997. The Talent Acquisition Centre and WSIB hiring parties will used this information to assess/validate your qualifications, determine if you meet the requirements of vacant positions and/or gather information relevant for recruitment purposes. If you have questions or concerns regarding the collection and use of your personal information, please contact the WSIB's Privacy Office at [email protected] The Privacy Office cannot provide information about the status of your application.



Application Instructions:



As a precondition of employment, the WSIB requires that prospective candidates undergo a criminal records name check any time before or after they are hired.



To apply for this position, please submit your application by the closing date at https://www.wsib.ca/en/careers



Additional Information:



Address:



- 10 Permanent, Toronto, Toronto Region



Compensation Group:



Excluded



Understanding the job ad - definitions



Schedule:



N/A



Category:



Consulting and Planning



Posted on:



Wednesday, November 17, 2021



Note:



- This posting is for an organization that is not a part of the Ontario Public Service. The information and tips on the Ontario Public Service Careers website may not apply to this posting. Please use the contact information below to contact the organization directly if you have questions.

The original job offer can be found in Kit Job:
https://www.kitjob.ca/job/21145789/eligibility-adjudicator-ocf-441-toronto/?utm_source=html

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