Adjudicator

Join to apply for the Adjudicator role at The Alberta School Employee Benefit Plan (ASEBP)

Full-time Contract (12-Month)

When it comes to employee satisfaction and workplace wellness, as one of Alberta's top employers, ASEBP doesn't just talk the talk. ASEBP is proud to be a health champion. The organization has built a healthy, positive, and inclusive workplace culture that supports employees' holistic well-being and fosters their personal and professional success. Benefits and perks include: 35‑hour work week.

• Hybrid workforce program: work from home the majority of the time and typically in office (Allendale Centre East) an average of 2‑4 days per month.
• Earned Day Off (EDO) program.
• Comprehensive benefits plan which includes extended health care, dental, and vision care.
• Health and wellness spending accounts.

ASEBP provides personal and workplace health benefits, programs, and disability case management services to support Alberta's public and Catholic education sector employees. By joining the Disability Services department as an adjudicator, you'll be a key member of a team supporting the new Sick Leave Support program and conducting impactful case management activities.

We're looking for a knowledgeable, passionate disability claims management professional who is excited about the opportunity to positively impact our covered members.

Reporting to one of the Supervisors, Disability Services, the adjudicator plays a key role in ASEBP's disability management process by determining a covered member's entitlement to benefits and services, and actively managing cases through the initial stages of sick leave and disability.

The adjudicator works with multiple stakeholders, including employers, covered members and health care providers to gather information to make timely and accurate eligibility and entitlement decisions. They will also facilitate assessments and treatments when appropriate. The adjudicator is the key contact for covered members throughout the initial period of disability and is responsible for active case management activities to promote recovery and the earliest, sustainable return to work for the covered member.

• Assess Sick Leave Support (SLS) application for eligibility to the SLS program and communicate if the absence is medically necessary to the covered member and employer.
• Gather relevant information and accurately interpret and apply plan provisions/program guidelines to determine covered member eligibility and entitlement to supportive services and Extended Disability Benefits (EDB).
• Apply a whole person approach to the adjudication process, where individual needs of the covered member and those of the employer are considered.
• Provide clear and timely communication with all stakeholders, both written and verbal. Ensure covered member understands the program, their responsibilities, and claim decisions.
• Respectfully communicate difficult or adverse decisions relating to program or benefit eligibility and entitlement.
• Keep accurate documentation using case management software. Prepare SLS, EDB and policy appeal summaries.

• Develop effective and timely proactive case management plans and provide active case management of claims through sick leave and early disability periods. This includes identifying and coordinating medical assessments, requesting medical information, expediting and coordinating treatment, and managing the funding of treatments with a focus on recovery.
• Engage all stakeholders to support coordination of treatment and promote early and sustained recovery and return to work plans.
• Apply best practice medical guidelines to support all case management and return to work activities and search and maintain current knowledge of disability management, community services and available resources.
• Coordinate return to work planning with employers. This includes proposing customized return to work plans in collaboration with the employer, monitoring plans, and making adjustments as needed with the goal of successful and sustainable return to work.
• Follow up with covered members to assess their…