Medical Review Consultant

Company: CGIC

Department: Claims

Employment Type: Regular Full-Time

Work Model: Hybrid (2 days in office)

Language: This role operates in English.

The Opportunity

We are a leading Canadian financial services co‑operative committed to being a catalyst for a sustainable and resilient society and our team is essential to deliver on this strategy. That’s why we prioritize our people, to ensure we provide a strong culture and development opportunities which enables our team to thrive and to live our purpose. The best part is that you will work with people that care passionately about you, our clients and our communities.

As the Medical Review Consultant, you will provide recommendations and interpretation to the Claims Team in order to support client decisions regarding rehabilitation plan of actions, disability management and benefit determinations considering medical documentation, regulations, and applicable case law.

You will support the team and our accident benefits portfolio in competitive excellence, people, and client experience. You are responsible for monitoring claims ensuring all have appropriate rehabilitation management plans that are being implemented in a proactive and effective manner. You will work with the claims team to provide insight, guidance, and oversight for the management of rehabilitation of our clients and identifies and/or creates resources and training opportunities for the claims team.

How You Will Create Impact

• Analyzing medical and other file information, document conflicting or corroborating evidence to support the rehabilitation and disability management of our clients, including appropriate treatment and return to work plans.
• Providing medical and rehabilitation recommendations to support client recovery throughout the life of a disability claim. Analyzing our claims decision and identifying risks to our trust and reputation, and address immediately with the team.
• Identifying additional medical or other claims related information required for the exposure to ensure appropriate recovery plans for our clients. Identifying potential risks and errors and recommend strategies to mitigate.
• Working closely collaboration with the claims team to monitor the client experience through ongoing meetings to review progress, create and adjust treatment plans, and liaise with referral sources. Medical research/expert knowledge of complex injuries, treatment protocols, causation, and outcomes.
• Preparing reports which outlines findings, strengths, opportunities, and recommendations. Manage and document feedback, identify and analyze trends, interpret data, and provide reports.
• Researching and applying extensive medical knowledge of relevant jurisdictional, legislation, tribunal and case law that comes from all levels of court in Canada. Interpret and apply complex regulations, multiple legislations apply over the range of claim dates.
• Serving as a mentor and resource to the claims team, offering guidance on complex cases, system use, and procedural best practices. Providing coaching, peer review, and informal training to enhance the skill development of the team.

To Join Our Team

• You have 3 to 5 years of relevant clinical experience or related field.
• You have a post‑secondary education in Medical, Insurance or related discipline.
• You have a Kinesiology, Physiotherapy, Occupational Therapy, Psychology, Nursing, or related medical discipline.
• You have a medical background as well as excellent working knowledge of injury and treatment protocols.
• You have the ability to critically analyze medical information and other claim documentation.
• You have expert ability to interpret and apply complex regulations from various legislative schemes – high level of knowledge about new and existing case law and the ability to apply findings to similar situations.

How You Will Succeed

• You have an innovative mindset to improve operational efficiencies and ability to influence change, with a primary focus on client needs.
• You use critical thinking skills to recognize assumptions, evaluate arguments, draw conclusions and proactively propose solutions.
• You have strong communication skills to clearly convey messages and explore diverse points of view.
• You build trusting relationships and provide guidance to support the development of colleagues.

What You Need To Know

• You are required to have your own vehicle, valid driver’s license and insurance.
• You will travel occasionally.
• Extended work hours, including evenings and weekends, may be required.
• You will be subject to a Background check as a condition of employment, in the event you are the successful candidate.

What’s in it for you?

• Training and development opportunities to grow your career.
• Flexible work options and paid time off to support your personal and family needs.
• A holistic approach to your well‑being, with physical and mental health programs and a supportive workplace culture.
• Paid volunteer days to give back to your community.
• In addition to our competitive salary and incentive programs, eligible employees also benefit from a comprehensive total rewards package including group retirement savings plans, pension and benefits (e.g., health and wellness, dental, disability and life coverage), mental health support and an employee assistance program.

Salary information

Expected salary range $72,847- $121,411 (min-max, full range).

Salary placement

The salary amount for the successful candidate is determined by Co‑operators in its discretion and will vary depending on several criteria including but not limited to: local market conditions, geography and relevant job‑related factors such as knowledge, skills, qualification, experience and education.

Incentive/Variable pay

Employees may also have the opportunity to participate in incentive programs and earn additional compensation tied to individual and/or business performance, or other business metrics.

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