City : Burnaby

Category : Disability & Life Insurance

Industry : Insurance

Employer : Pacific Blue Cross

Pacific Blue Cross has been British Columbia's leading benefits provider for 80 years. We are an independent, not-for-profit society with strong roots in BC’s health care system. Together with our subsidiary BC Life, 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 Pacific Blue Cross Health Foundation, we also provide funding to community organizations with a focus on alleviating mental illness and chronic disease. We're interested in finding people who want to make a difference and who will take advantage of every opportunity to build a career with us.

Pacific Blue Cross offers an attractive compensation and benefits package, fitness programs, and an onsite gym and cafeteria. Our workplace culture values health and wellness, continuing education, environmental sustainability and giving back to the community.

We are currently recruiting for two Disability Claims Specialists to join our Work & Wellness claims team. The is a temporary contract role (up to 12 months) and will require working from both, office and home (hybrid).

Job Summary

Under the general supervision of the area Supervisor, provides professional disability claims services to insured clients including organizing, reviewing, analyzing and investigating claims information from a variety of sources, determining adjudication and assessment actions required to process short term disability claims and initiating referrals or escalation to other internal or external disability resources where intervention or case management is required, Prepares and presents pending short term disability claims and related recommendations to the disability team for discussion and review, monitors active claims on an ongoing basis and communicates claims-related decisions directly to clients and applicants. Generates payments for authorized short term disability claims.

Job Duties

Work & Wellness Disability Claims Adjudication and Assessment

o Provides professional disability claims services to insured clients and ensure claims are coordinated within contractual terms and conditions of eligibility and coverage by:

• organizing, reviewing, analyzing and investigating claims and eligibility information from a variety of sources;
• interpreting and applying contract wording, medical reports, claims policies and procedures, statutory requirements and other guidelines affecting valuation and disposition of short and long term disability claims;
• investigating pre-existing limitations to determine impact on eligibility and valuation;
• interviewing claimants, policy-holders, employers, doctors, lawyers, brokers, third parties and other stakeholders in the disability claims process to verify claims information, determine status of accommodation and return to work, and identify the potential for current and future intervention and case management services;
• initiating referrals or escalation to other internal or external disability resources where intervention or case management is required; and
• adjudicating claims where intervention is not required, including keying claims data into claims processing systems and documenting all contacts made and actions taken.

Customer, Client and Member Service

o Staffs the department’s incoming phone queue by receiving, screening and responding to general and specific claims inquiries from external contacts.

General Team and Department Support

o Maintains up to date knowledge of disability management practices, policies and procedures, system requirements and other information related to the provision of disability management services through continuous learning initiatives.

o On a one to one basis, supports new employees by demonstrating the execution of specific tasks and duties, and sharing knowledge and experience on request.

Qualifications

• Certificate or diploma in Health, Psychology, Kinesiology, Nursing, Disability Management or Business program, or combination of education and experience in the medical field
• 2 years previously related experience in Benefits Claims, Health or Kinesiology roles, or equivalent
  • Experience with group disability claims would be an asset
  • Broad knowledge of Medical terminology
• Demonstrated decision making and critical thinking skills
• Demonstrated oral/written communication skills
• Demonstrated proficiency in Basic Word
• Minimum typing skills of 40 wpm

While we thank all candidates for their interest, only shortlisted candidates will be contacted.

We strive to create a workplace where everyone feels valued and employees feel empowered to freely participate and contribute regardless of race, ethnicity, gender, sexual orientation, religion, ability, education level, parental status, or socioeconomic status. PBC is an equal opportunity employer and welcomes applications from all qualified candidates.

To request an accommodation in completing this application, pre-employment testing, interviewing or otherwise participating in the employee selection process, please direct your inquiries to careers@pac.bluecross.ca.