Adjudicator (Permanent)

at  ASEBP

ADJUDICATOR, DISABILITY SERVICES

Status: Full-Time
Employment type: Permanent
Competition Number: 24-78
Area: Disability Services
Salary: Starting salary $80,000
Closing date: October 31, 2024, at 4 p.m.

WHY ASEBP?

When it comes to employee satisfaction and workplace wellness, as one of Alberta’s top employers, ASEBP doesn’t just talk the talk. ASEBP is proud to be a health champion. The organization has built a healthy, positive, and inclusive workplace culture that supports employees’ holistic well-being and fosters their personal and professional success. Benefits and perks, include:

• 35-hour work week
• This role is eligible to participate in the hybrid workforce program, working from home the majority of the time and typically working in office an average of 2-4 days per month
• Earned Day Off (EDO) program
• A comprehensive benefits plan which includes extended health care, dental, and vision care
• Health and wellness spending accounts
• Defined-benefit pension plan (through LAPP)
• Training and professional development allowance

For a full list of benefits, please visit asebp.ca/careers.
ASEBP provides personal and workplace health benefits, programs, and disability case management services to support Alberta’s public and Catholic education sector employees. By joining the Disability Services department as an adjudicator, you’ll be a key member of an growth-focused team supporting the new Sick Leave Support program and conducting impactful case management activities.
We’re looking for knowledgeable, passionate claims management professionals who are excited about the opportunity to positively impact our covered members to join our growing team.
Reporting to one of the Supervisors, Disability Services, the adjudicator plays a key role in ASEBP’s disability management process by determining a covered member’s entitlement to benefits and services, and actively managing cases through the initial stages of sick leave and disability.
The adjudicator works will multiple stakeholders, including employers, covered members and health care providers to gather information to make timely and accurate eligibility and entitlement decisions. They will also facilitate assessments and treatments when appropriate. The adjudicator is the key contact for covered members throughout the initial period of disability and is responsible for active case management activities to promote recovery and the earliest, sustainable return to work for the covered member.

YOUR EDUCATION AND EXPERIENCE

• 2 to 5 years of disability case management experience with an insurance company and/or employer environment, active case management or equivalent clinical work. Previous experience in a healthcare capacity is an asset.
• A diploma or degree in disability management or other health related field, such as Occupational Health Nursing, Community Health, Social Work, Vocational Rehabilitation or Psychology.
• A disability management certification.
  A combination of education and experience may be considered.

YOUR ABILITIES

• Objectively analyze medical information (at times complex in nature) and use strong judgement and decision-making skills.
• Build relationships and sort through issues to create win-win-win solutions while also dealing with emotional and/or challenging individuals.
• Skilled in explaining complex information and/or delivering challenging or potentially contentious information.
• Exceptional organizational, priority setting and time management skills.
• Strong computer skills including use of best practice medical guidelines and a case management program to document case activities, manage priorities/claims.
• Proficiency with Microsoft Office Suite and programs such as Outlook, Word, Excel, Teams, and Adobe.
• Demonstrated ability to work independently and collaboratively within a team environment.

Benefit decision making and communication

• Assess Sick Leave Support (SLS) application for eligibility to the SLS program and communicate if the absence is medically necessary to the covered member and employer
• Gather relevant information and accurately interpret and apply plan provisions/program guidelines to determine covered member eligibility and entitlement to supportive services and Extended Disability Benefits (EDB).
• Apply a whole person approach to the adjudication process, where individual needs of the covered member and those of the employer are considered.
• Provide clear and timely communication with all stakeholders, both written and verbal. Ensure covered member understands the program, their responsibilities, and claim decisions.
• Respectfully communicate difficult or adverse decisions relating to program or benefit eligibility and entitlement.
• Keep accurate documentation using case management software. Prepare SLS, EDB and policy appeal summaries.

Active Case Management

• Develop effective and timely proactive case management plans and provide active case management of claims through sick leave and early disability periods. This includes identifying and coordinating medical assessments, requesting medical information, expediting and coordinating treatment, and managing the funding of treatments with a focus on recovery.
• Engage all stakeholders to support coordination of treatment and promote early and sustained recovery and return to work plans.
• Apply best practice medical guidelines to support all case management and return to work activities and search and maintain current knowledge of disability management, community services and available resources.
• Coordinate return to work planning with employers. This includes proposing customized return to work plans in collaboration with the employer, monitoring plans, and making adjustments as needed with the goal of successful and sustainable return to work.
• Follow up with covered members to assess their perception of health and functioning, and to discuss information obtained through medical reporting/assessments, with a goal of fostering shared understanding of progress and next steps towards recovery and return to work, as appropriate.
• Timely documentation and preparation of confidential information, including reports, letters, and case notes.
• Alert appropriate ASEBP staff on issues and trends identified through interactions with covered members and stakeholders.
• Manage the appropriate use of discretionary spending including invoice processing.
• Occasional travel to conduct face-to-face meetings with covered members, employers, client representatives, and health care providers to foster relationships and facilitate successful return to work plans.

Department and team support

• Attend and participate in team meetings, training, and activities.
• Support training of new employees as needed.
• Provide subject matter expertise to other ASEBP departments.
• Participate in working groups, projects, external information sessions or stakeholder meetings as needed.