Claims Coordinator

At Disability Management Institute (DMI), we deliver innovative, end-to-end disability and absence management solutions that transform how employers support their teams. Since 2002, our experienced team of dedicated professionals have combined deep expertise with genuine care to create partnerships that benefit employees, employers, and stakeholders alike.

Our culture thrives on connection, collaboration, and respect. Open communication, team bonding, and a spirit of appreciation create an environment where you feel supported, valued, and empowered to bring your authentic self to work every day.

The Payment & Claims Coordinator serves as the main support to the Claims teams for anything related to benefit calculations and claims-specific administration. As a member of the Claims team, the Payment & Claims Coordinator will manage a caseload of weekly and monthly calculations but will also be responsible for financial audits and other administrative projects.

Within 30 days:

• Familiarize yourself with our claims management and payment systems as well as our standard insurance booklet/policies
• Meet with point people in other departments (DMI Admin, Finance, CSBT)

Within 60 days:

• Gain a level of comfort with our payment system (WEBS) that will allow data correction and recalculation if necessary
• Review the current benefits calculation training information/resources

Within 90 days:

• With the Supervisor, identify calculation audits that will be completed to ensure existing claims have been handled correctly
• Identify any areas of opportunity for training that will drive further position objectives
• Take ownership of the WAWR and COLA blocks of calculations

• Operate automated claims payment system and perform manual calculations as required. Following training period, a minimum of 95% accuracy is required.
• Acts as the subject matter expert and supports team members accordingly with respect to Benefit Calculations (including WEBS entries and corrections).
• Review current training material and work with Training team to update/create appropriate content and resources. Review and update on regular basis as applicable.
• Assists with Quality Control reviews related to benefit calculations completed by the Case Managers.
• May use governance and metrics reporting to assist in identifying benefit calculation audit lists, CPP application requirements, and/or potential for alternate resolution opportunities.
• Serves as a key resource for clients and partners when benefit calculations are questioned.
• May attend client and/or partner meetings if benefit calculations are a point of concern or confusion.
• Works collaboratively with all parts of the Claims department as well as other departments to ensure consistency of processes throughout the organization.
• Calculations include rehabilitation, all-source maximum, offset, cost of living, over and under-payments, settlements.
• Responsible for the recovery of all over payments including explanation letters, follow up letters, referrals to Collection agency, reporting.
• Interpret contract wording that may be standard, non-standard, and potentially unique, and then correctly apply that wording to perform complicated calculations
• Benefit calculations completed both manually and within our claims payment system if required
• Benefit and adjustment calculations can include:
  Canada Pension Plan (CPP), EI Sub plan, Survivor Benefit payments, Maternity Leave benefit payments, Severance payments, Workplace Safety and Insurance Board (WSIB), Auto Insurance, garnishments, and subrogation.
• Draft and deliver written correspondence explaining how benefits have been calculated and any necessary next steps.
• May process some disability payments under the direction of the Claims leaders.
• Provide information to plan administrators, members, affiliates and other members of the Group Life and Disability Claims department which includes verifying claim information and responding to various inquiries and information requests.
• Maintaining a comprehensive log and diary system to track payments, follow-ups, calculations, and claim status.
• Maintain confidentiality over client and corporate records.
• Other duties as assigned including administration duties related to the Disability and Living Benefits teams (including Maintenance claims).

• Minimum of 3 years’ experience in group disability claims insurance (this can include administrative roles).
• Post-secondary education in accounting, business, mathematics is recommended.
• Working knowledge of Microsoft Office Suite, especially Excel

You will succeed in this role if you are:

• An Effective Communicator – You communicate clearly and in a positive manner. You can interact with others to build relationships through tact and diplomacy, while navigating through difficult situations and conversations.
• Client Centric – You prioritize and take action based on the needs of both internal and external clients. You exhibit…