Disability Claims Specialist

Pacific Blue Cross (PBC) has been British Columbia's leading benefits provider for over
80 years. We are an independent, not-for-profit society with strong roots in BC’s health care system. 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 PBC Health Foundation, we fund projects that improve health outcomes directly related to mental health and wellbeing as well as the prevention and/or management of chronic disease. We are interested in finding people who want to make a difference and who are looking to grow their career with us.

• Work-life balance with flexible working hours of 7 hours per day, Monday to Friday (i.e., 35 hours per week).
• Paid vacation starts at 3 weeks per year, and increases with years of service.
• Hybrid work environment (i.e., a combination of work from office and work from home days).
• Generous benefits, including extended health, dental, and life insurance; these benefit premiums are 100% paid by PBC.
• Company pension contributions after 1 year of service.
• Education allowance up to $1,000 per calendar year.
• Onsite gym, cafeteria, and access to virtual doctors/counsellors 24/7 via our Employee Family Assistance Program!

• We are searching for 1
  
  Temporary Disability Claims Specialist to join our Work and Wellness team.
• This position is unionized and part of the CUPE 1816 Bargaining Unit. This position is paid at hourly rates and receives wage increases in accordance with the Collective Agreement. The wage for this position is: $5,038 - $5,880 per month.

Under general supervision of the Supervisor, Work and Wellness (W&W), the Disability Claims Specialist provides professional disability claims services to clients and applicants including 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.

This position prepares and presents pending short-term disability claims and related recommendations to the disability team for discussion and review. This position monitors and updates active claims on an ongoing basis and communicates claims-related decisions directly to clients and applicants. This position generates payments for authorized short-term disability claims.

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

• reviewing, analyzing, and investigating claims and history/conditions of claimants to determine eligibility information from a variety of sources as well as requesting and documenting additional information as required.
• interpreting and applying contract wording, medical documentation, claims policies and procedures, statutory requirements and other guidelines affecting valuation and disposition of short-term disability claims.
• initiating regular telephone contact with claimants, policy-holders, employers, doctors, lawyers, brokers, third parties and other stakeholders in the disability claims process to gather additional information, including the application of appropriate questioning techniques to obtain information determining level of functioning, determining status of accommodation, and return-to-work options.
• planning the content of and composing a variety of written correspondence and documents which adhere to the established standards of business communications and internal style guidelines.
• adjudicating claims including keying claims data into claims processing systems, documenting all contacts made and actions taken, processing payments, providing claim updates, and maintaining files. Referring claims to other internal or external disability stakeholders where intervention or case management is required.
• acting as liaison with Finance on third party claims to ensure over payments are identified and followed up, or on an occasional basis, manually calculating amounts owing based on policy provisions.
• identifying and calculating amounts for recovery where Work Safe benefits, other sources of income/benefits, motor vehicle accidents prior to 2019, or earlier than expected return to work have or may result in over payment; communicates recovery amounts and expectations for repayment to all affected parties, and follows up to ensure collection.

Prepares and presents pending short term disability claims and related recommendations to the disability team for discussion and review. Supports findings and justifies acceptance or denial of claim, including presentation of options for more complex and/or…