Workers’ Compensation Claims Consultant – Level 2

This is a fully remote position, open to applicants in Canada.

📋 Description

• Evaluate and handle intricate or technically demanding workers’ compensation claims by investigating and collecting information to assess claim exposure.

• Oversee claims through strategic action plans to ensure suitable and timely resolutions.

• Negotiate claim settlements within the established authority limits.

• Calculate and allocate necessary reserves promptly and ensure their adequacy throughout the claim's duration.

• Calculate and disburse owed benefits; approve and process payments and adjustments; settle claims within authority limits.

• Prepare necessary provincial filings within required statutory deadlines.

• Manage the litigation process to ensure swift, cost-effective resolutions.

• Coordinate recommendations from vendors for further investigations or litigation management.

• Implement cost-containment strategies, including strategic partnerships with vendors.

• Oversee recoveries, including subrogation, Second Injury Fund recoveries, and offsets from Social Security and Medicare.

• Report claims to excess insurers and respond professionally to requests for guidance.

• Communicate claim activities and management with claimants and clients.

• Maintain professional relationships with clients.

• Ensure proper documentation of files and accurate coding.

• Refer cases to supervisors and management as needed.

• Carry out additional duties as assigned.

• Support the organization's quality initiatives.

• Travel as needed.

⛳️ Requirements

• Bachelor’s degree from an accredited university or college is preferred.

• Four (4) years of claims management experience, or a combination of education and experience equivalent.

• Five (5) years of claims management experience, or a combination of education and experience equivalent, is required.

• Proficient understanding of relevant regulations, compensation and offsets, disability duration, medical management practices, and Social Security and Medicare claim procedures pertinent to the applicable line of business.

• Strong knowledge of workers’ compensation legislation and health and safety standards.

• Demonstrated ability to navigate complex claims processes and collaborate effectively with stakeholders.

• Experience with HR leave programs, disability case management, and interpretation of policies.

• Paralegal proficiency in managing claims, appeals, and compliance issues.

• Exceptional oral and written communication skills, including presentation capabilities.

• Proficient in computer applications, including Microsoft Office products.

• Strong analytical and interpretative abilities.

• Excellent organizational skills.

• Good interpersonal abilities.

• Outstanding negotiation skills.

• Capacity to work efficiently within a team environment.

• Ability to meet or surpass service expectations.

• Professional certification relevant to the line of business is preferred.

• Willingness to travel as required.

🏝️ Benefits

• Work-life balance

• Caring culture

• Inclusive, barrier-free recruitment and selection processes

• Accommodation available during recruitment and selection, if required