Long Duration Claims Coordinator

WHO ARE WE?   Disability Management Institute (DMI) offers small and medium sized employers flexible innovative solutions to their disability management needs. Our specialties include: WCB/WSIB Claims Management, Self-Funded Sick Leave Adjudication, and Non Occupational Absence Management, Return to Work Planning and Disability Management. Ranging in size from 5-2500 employees our clients span the public and private sectors and cover a wide range of industries.  

YOUR ROLE

As Long Duration Claims Coordinator, you will coordinate and manage Long Term Disability claims approved beyond Change of Definition (COD) that have been identified appropriate as maintenance / long duration claims within established timeframes and within the scope of the policy while ensuring excellent customer service. This is a remote role within Canada.

 

WHAT TO EXPECT

• Work with the Senior LTD CM and Supervisor to develop the checklists, criteria and processes for identifying maintenance claims. 
• Review listings of LTD claims approved beyond COD to identify based on specific criteria, the claims appropriate maintenance claims. 
• Follow processes to accurately document a reviewed claim as an appropriate or inappropriate maintenance claim. This may include DMS, checklists, spreadsheets, etc.
• Work with LTD team (including CMs, Seniors, Supervisors, Payment & Claim Coordinators) to implement the full process.
• Apply appropriate case management skills while adhering to defined processes for managing maintenance claims. 
• Provide proactive communication to claimants to keep them apprised of claim status updates and claim progression ensuring service standards are met.
• Triage claims for rehab potential, return to work potential, alternate resolution potential in concert with the Senior LTD CM and additional resources such as Rehab, Settlement Specialist, etc. 
• Apply the appropriate policy provisions when reviewing claims and render ongoing decisions.

 

YOUR IMPACT

• Follow processes to accurately document a reviewed claim to identify as an appropriate or inappropriate maintenance claim.
• Work with LTD CMs to educate them on additional information required or steps that need to be taken before a claim should be referred to the Long Duration Claims Coordinator.
• If benefit calculations required, refer to the Payment & Claim Coordinator to complete the calculation for cost of living, offsets, etc. 
• Utilize the internal task system for ongoing monitoring of maintenance claims.
• Interview claimants to gather relevant claim information on a regular basis.
• Utilize available resources to assess diagnosis and treatment plans as needed when medical updates are obtained. Where appropriate liaise in a professional manner with doctors, medical consultants, lawyers, etc., ensuring that only allowable information is released to recognized recipients and that all information is released in writing.
• Draft and deliver written correspondence identifying claim activity and next steps.
• Participate in claim conference calls with Senior LTD CMs/Supervisors/Managers as necessary.
• Work collaboratively with Rehab or the Settlement Specialist when these services have been identified as potential opportunities. 
• Maintain confidentiality over client and corporate records and medical claims information.
• Operate automated claims payment system and perform manual calculations as required.  
• Diligence regarding data field population and updates
• May be asked to assist with overflow administrative duties on the Claims teams.
• Other duties as requested by Management (related to Claims Adjudication)

 

THIS IS YOU

• Minimum 5 years of claims experience in a group insurance environment

 

THIS IS NICE

• Post-secondary degree or diploma or equivalent experience. Familiarity with medical terminology and disability contract language an asset.
• CEBS, CIP, or LOMA designations (an asset).
• Medical background an asset (i.e. Occupational Therapist, Kinesiology, Nursing, Physiotherapist)

 

WHAT YOU'LL GET   In addition to becoming part of a creative, challenging, and stimulating work environment, we also offer:

• Our company-wide vacation policy guarantees a minimum of 3 weeks' vacation
• Flex days to help you achieve that work-life balance
• Wellness programs to support you in and out of the office
• Learn and grow with us through our employee education program
• Participation in our Happy Friday program

 

YOUR COMPENSATION

At the time of this posting, the estimated annual base salary pay range for this position is $65,000-$75,000. Individual compensation within this range is determined by factors such as job-related skills, relevant experience, and education/training. This range reflects the annual base salary only pay and does not encompass our comprehensive total rewards, benefits, and potential bonuses that we proudly offer. 

 

WHY YOU WILL LOVE WORKING FOR DMI

Professional Development   

We are a fast-growing company and as a result, there are ample opportunities for career growth and professional development when you join our team. From a transparent promotion structure and defined career paths to a wide range of learning and development opportunities, we do what it takes to invest in your career and help you hone your skills so you can grow alongside us!   

Health & Wellness Benefits   

We offer a comprehensive array of health and wellness benefits that provide choices so you can tune your benefits plan to fit your unique needs.   

Events and Socials   

When you join our team, you’ll enjoy everything from virtual company-wide teaching and training days, industry events, Happy Fridays, team social events and much more!   

  We thank everyone who applies to the Long Duration Claims Coordinator role; however, due to the volume of applications we receive, we are only able to contact candidates who have been selected for an interview. Apply