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Reporting to the Manager, Group Life and Disability Claims, the incumbent is responsible for processing short and long-term disability claims in order to determine if the participant is eligible for disability benefits while relying on medical reports deemed necessary as well as related policies and procedures. The case manager must develop a case management plan for every claim.
Assess disability claims and determine eligibility for benefits via telephone interview while into consideration medical information and contractual provisions, as well as pursuing additional information to make a sound decision
Conduct detailed telephone interviews to obtain the pertinent medical and non-medical information which has not already been obtained
Develop and execute a case management plan
Assess and identify the non medical factors and the functional limitations which are likely to influence the duration of disability and to facilitate the return to work in collaboration with a rehabilitation team.
Determine the gradual return to work plan in collaboration with the attending physician, participant, and policyholder, as needed
Communicate with policy holders, participants, health professionals, other services providers as well as various level of government in writing, by email, telephone, and fax. The Case Manager must also manage difficult calls with dissatisfied and potentially irate callers as a result of a decision to deny benefits
Maintain the participant's file in the system
Commit to providing a high level of service
Actively and proactively manage disability claims and using all sources available including IME's and other resources available.
Responsible for all billing of EI (Early Intervention)
Attends meetings with clients and suppliers
Provides assistance with special projects
Post Secondary Education in Health Sciences, Human Resources, Psychology or a related discipline and 4 to 5 years of related work experience
Fluently Bilingual (French and English, written and spoken)
Excellent communication skills
Well organized individual with strong analytical skills, excellent problem solving ability, and ability to work with minimal supervision
Positive attitude, the ability to work well in a fast paced and demanding work environment
Ability to work with multiple deadlines
Adaptability and flexibility are necessary in this role
Knowledge of occupational health and safety and medical terminology
Customer Service oriented
Ability to work in a multifunctional team environment