Start Date
Immediate
Expiry Date
01 Sep, 25
Salary
5600.0
Posted On
01 Jun, 25
Experience
0 year(s) or above
Remote Job
Yes
Telecommute
Yes
Sponsor Visa
No
Skills
Disability Claims Management, Early Intervention, Assessment, Rehabilitation Services, Interventions, Oversight, Completion, Eligibility, Contractual Obligations, Referrals, Functional Capacity Evaluations, Case Management Services, Functionality, Rehabilitation
Industry
Insurance
ABOUT PACIFIC BLUE CROSS
Pacific Blue Cross (PBC) has been British Columbia’s leading benefits provider for over 80 years. 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. We are interested in finding people who want to make a difference and who are looking to grow their career with us.
JOB SUMMARY
Under the general supervision of the Supervisor, Work & Wellness (W&W), the Disability Claims Management Specialist 2 provides the full range of professional disability and waiver of premium claims services to insured clients and Administrative Services Only (ASO) applicants undergoing review, and ensures claims are coordinated and managed within contractual terms and conditions of eligibility and coverage including reviewing, analyzing, and investigating claims information from a variety of sources, determining adjudication, assessment and intervention actions affecting short- and long-term disability claims management, payment and duration including those of a complex nature; develops cost/benefit analyses; develops case management plans; coordinates settlements; coordinates referrals to internal stakeholders for rehabilitation; coordinates the use of external service providers; develops and implements return-to-work initiatives and conducts reviews of ongoing cases; responds to appeals for declined claims; manages claimant and client relationships; and, actively participates in conference calls with selected groups to build ongoing relationships.
DISABILITY CLAIMS ADJUDICATION, ASSESSMENT, INTERVENTION AND CASE MANAGEMENT
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- and long-term disability claims.
identifying and following up on variances in policy and structure set up in the claims adjudication system or other deficiencies such as variances between policy provisions and eligibility.
regularly reviewing high intervention short-term and long-term disability cases to facilitate treatment optimization and return-to-work planning through referrals to internal and external stakeholders as required.
checking system-generated payment calculations for accuracy, processing gradual return-to-work earnings, performing manual calculations to determine a variety of benefit payment and adjustment amounts, overriding system limitations where required, and ensuring accurate coding of short- and long-term disability claims.
identifying and calculating amounts for recovery where Canadian Pension Plan (CPP), Workers’ Compensation Board (WCB) benefits, other sources of income/benefits, motor vehicle accidents prior to 2019, or earlier than expected return-to-work have or may result in overpayment; communicates recovery amounts and expectations for repayment to all affected parties, and follows up to ensure recovery.
QUALIFICATIONS: