Description

Employer Job Number: GO-00621364
Facility: 3sHealth
Job Description: The Employee Benefits team, in collaboration with health system partners, has embarked on a 3-year strategic plan to re-design the disability claims management model. This plan includes reframing claims management from adjudication to an active case management approach. This change positions the Claims Services area to provide improved service and collaborative support with plan members on their path to health.

Our Claims Services team is hiring a Claims Adjudicator who will be responsible for assessing and managing short and long-term disability claims to resolution. This includes determining if the claimants are eligible for benefit payments and developing appropriate action plans for each claim. The Adjudicator works in partnership with claimants, member organizations, unions, lawyers, physicians and rehabilitation consultants. The Claims Adjudicator makes timely decisions based on medical information, vocational components, and plan policies, while effectively and proactively managing a caseload of ongoing claims.

Required Qualifications

Degree/Certification in Human Resources, Disability Management or Occupational Health and Safety is preferred
Experience in vocational rehabilitation, disability management or attendance support would be an asset
Experience

A minimum of 5 years' experience in insurance and/or disability claims adjudication, or an equivalent combination of education and experience.

Medical experience obtained through claims assessing, underwriting, nursing or a health profession is an asset.

Knowledge, Skills and Abilities

Ability to work independently and as a member of a multi-disciplinary team
Demonstrated ability to establish and maintain effective working re
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