City : MISSISSAUGA, Ontario, Canada

Category : Operations

Industry : Financial/Banking

Employer : RBC

What is the opportunity?

 *We're currently hiring - Apply Now!  Hybrid or Primarily Remote work

As a Bilingual Disability Claims Specialist you will adjudicate and manage disability claims in a team-oriented, multi-disciplinary, fast paced digital environment to ensure established service level standards are met by managing a caseload of short or long-term disability claims in accordance with unit procedures while delivering superior client service. You will be responsible for each stage of the disability claims adjudication processes, from initial assessment of medical information and policy provisions to render a decision, to building the best case management plan which includes but is not limited to: identifying the different supports needed for each case, monitoring treatment and the achievement of the plan and working with the claimant, employer and providers involved in the case for a return to work. You will be required to apply appropriate risk management strategies which impact the company’s financial results, reputation and regulatory risks, client relationships, and business retention.

What will you do?
• Adjudicate English and French claims utilizing a multidisciplinary claim management model to; ensure objective, fair and thorough claim adjudication, comply with practices and procedures and regulatory requirements, provide the highest level of customer service and manage reputational risk and, develop and implement claims management and return to work strategies on assigned caseloads where warranted.

• Active case management of files by documenting the facts, analysis and appropriate next steps while effectively applying the adjudication process; provide ongoing and regular communication with all stakeholders of claim, assess use of different claim tools and programs, review and request ongoing medical as needed, provide ongoing assessment of key dates within the lifecycle of the claim (COD etc.) and ensuring case management plans are updated regularly.
• Accountability and responsibility to ensure that the management of required tasks within the assigned case load meets all service level standards.  
• Manage a large caseload of disability claims 

• Render decisions on a timely basis and effectively communicate these decisions, at times potentially difficult decisions and manage escalations with employers and claimants.
• Build effective relationships with key stakeholders and claimants to support recovery and return to work.
• Professionally communicate outcomes to our clients
• Given the very sensitive nature of the information gathered in the adjudication process, extreme care must be exercised in the handling of a claim in order to guard against any breach of confidentiality
• Effectively communicate and build rapport with team members, stakeholders, business partners and claimants to support recovery and return to work using a variety of techniques and collaboration from initiation to close
 

What will you need to succeed?

Must-have
• Post-secondary university degree or college diploma completed preferably in health sciences or a related field and a minimum 2 years of Short or Long Term Disability claims case management experience.

• Experience in effectively managing complex claims

• Strong analytical and decision making skills.

• Motivation to learn and adapt to change.

• Excellent organizational skills and the ability to multitask, work under pressure within a stressful working environment to handle high demands, meet tight targets and deadlines, and balance multiple goals and priorities
• Excellent communication skills in both English and French (written and spoken) to successfully partner and influence various stakeholders including the claimant, their treatment providers and physicians, the employer, group administrators, brokers, human resources, and lawyers.
• Demonstrated ability to effectively deal with customers in a manner that is professional with a high degree of customer service, including emotional calls and mental health clients.

• Excellent customer service and telephone skills and the ability to communicate complex and difficult information clearly with tact and high level of empathy.
• A general understanding of the health care and insurance fields, health related terminology (English & French), concepts of accommodation and return to work.  .
• A good understanding of contract wording and the ability to thoroughly review medical reports (English & French) and other tools available.

• Microsoft Office and experience working with multiple computer systems

Nice-to-have

• Ability to effectively manage change.

What's in it for you?
• A Total Rewards program that includes flexible benefits, work/life balance and career development programs and investment and retirement savings plans
• Competitive pay and high-earning potential
• All the tools, training, and team support you need to grow your career
• Flexible work/life balance options
• Sophisticated RBCI software tools to boost your productivity