Claims Review Specialist / Adjudicator
A leading organization in the workplace injury compensation sector is seeking ten professionals to manage medium risk claims under a case management methodology. These professionals will be responsible for adjudicating entitlement, setting initial rates, and overseeing claims through to completion. Their work includes determining client eligibility for permanent impairment benefits, monitoring claims through action plans, liaising with employers and service providers, identifying and addressing barriers to return to work, approving services and benefits, and ensuring compliance with the Workers’ Compensation Act and related policies.
What is in it for you :
- Salary band : $63.000 to $79.000, depending on experience.
- Permanent & full-time position
- Unionized environment : Covered under a collective agreement.
- Work schedule : 35-hour per week with core hours of 8 : 00 am to 4 : 30 pm.
- Hybrid work : One in-office day per week, typically for team meetings.
- Work program : Option to have every second Monday or Friday off by working an extra 45 minutes daily, available after 3 months of employment.
- Vacation : Earns 1.25 days per month, up to 15 days per year.
- Float days : Up to 4 paid float days per year, earned quarterly.
- Health & dental benefits : 100% coverage for prescription drugs, paramedical practitioners (up to $600 per year per practitioner), vision care, hospital accommodations, private duty nursing, and more.
- Health spending account (HSA) : Annual employer-funded credits for additional health and dental expenses.
- Pension plan : Defined benefit plan with employer matching contributions (8.4%, increasing to 10.9% for salary above $71.300).
Responsibilities :
Adjudicate and approve benefits for injured workers with medium-risk claims, including those with a compensable permanent impairment.Develop and implement action plans to ensure injured workers receive effective services that facilitate their safe and timely return to work.Coordinate and monitor all necessary services, treatments, and benefits for eligible clients.Communicate with employers, unions, medical professionals, and other service providers to assess claims and determine necessary interventions.Identify and address any barriers to return to work and implement appropriate solutions.Approve and authorize earnings replacement benefits, medical aid, and permanent impairment benefits.Assess entitlement to wage loss replacement and calculate awards based on the Workers’ Compensation Act and related policies.Ensure compliance with workplace safety regulations and maintain confidentiality of sensitive information.Travel as part of case management responsibilities (access to a vehicle is required).What you will need to succeed :
University degree in health care, education, or social sciences.2 years of experience in low- or medium-risk case management in a decision-making role within patient care, social services, health care, insurance, disability case management, or a related field.Equivalent combinations of education in another field and significant case management experience may be considered.Strong planning and organizational skills to manage multiple cases efficiently.Ability to analyze information, identify problems, and develop logical action plans.Effective decision-making based on analysis, experience, and judgment.Excellent communication skills, with the ability to convey complex information clearly across various channels.Experience guiding workplace parties through the return-to-work process.Strong negotiation skills to facilitate agreements between multiple stakeholders.Ability to establish and maintain productive relationships with internal and external partners.Knowledge of legislative insurance regulations and statutory requirements related to claims management.Experience in case coordination, including assessing, planning, implementing, and monitoring cases for effective resolution.Understanding of healthcare systems and the coordination of medical services for clients.Driver’s License Requirement : Required for case conferencing; minimal travel expected.Why Recruit Action?
Recruit Action (agency permit : AP-2000003) provides recruitment services through quality support and a personalized approach to job seekers and businesses. Only candidates who match hiring criteria will be contacted.
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