Disability Claims Management (Intake and Early Intervention Program)
If you are a skilled disability case management professional who has experience working with individuals who are ill or injured regain their health and return to work, then this could be the job for you!
This role helps individuals address their health issues early in the onset of illness or injury with a goal to support them remaining at work with modified hours/duties or to return to work within the elimination period, or to support them during the Extended Disability Benefit (EDB) application process if required. This role builds relationships with covered members participating in ASEBP’s Early Intervention Program (EIP) and works with health care providers, the employer group, the covered member and their representatives to ensure a supported return to work plan is in place. This position also includes EIP eligibility decision making, case management, coordination of medical assessments; requests for medical information; expedited treatment; and coordination and funding of treatments, as required.
Your Key Responsibilities
- Liaise with the employer group to keep them updated on the status of the client’s EDB application.
- Build early relationships with covered members and guide them through the initial EDB process (client intake).
- Coordinate the initial adjudication of EDB applications.
- Coordinate referrals for medical assessments and/or functional capacity evaluations to assist in adjudication of the EDB application as required.
- Assess the claim application for eligibility to participate in the EIP program.
- Adjudicate decisions regarding eligibility for EIP and rehabilitation programs.
- Apply a holistic approach to the adjudication process, considering individual needs of the client and the employer.
- Effectively communicate and manage the results of difficult or adverse decisions.
- Speak with covered members who are struggling with health issues to help them develop a plan to address their health concerns.
- Request information from the covered member, health care providers and employer group to assess anticipated recovery time, develop an action plan in support of modified work hours or gradual return to full-time equivalent, and to modify the plan as needed.
- Link covered members to appropriate community resources and ensure they are aware of their benefit coverage.
- Follow-up with covered members to assess their perception of health and foster a shared understanding of progress and next steps.
- Liaise with employer group personnel regarding individuals with short-term health issues; provide advice to ensure that the health issues are addressed with appropriate resources and creative options and strategies in the workplace are implemented to support the individual’s ability to remain at work.
- Monitor the success of the modified/gradual return to work plan and make adjustments as needed.
Your Education and Experience
- Two to five years of health experience in disability management, case management or equivalent clinical work.
- Health-related degree or diploma in disability management or equivalent.
A combination of education and experience may be considered.
- A caring, supportive approach that considers the “whole person” rather than a narrower medical management approach.
- Exceptional organizational skills with an ability to prioritize work and manage a busy portfolio with ease and efficiency.
- A collaborative and integrated approach to work, with a demonstrated ability to work as part of a team to best serve our covered members.
- A positive perspective and flexibility to deal with complex and challenging situations that might arise.
- A creative approach to solving issues and resolving barriers that are preventing individuals from remaining at work and/or returning to work.
Unique Working Conditions
You will be working with groups across the province, so some travel may be required in this role. Due to the current COVID-19 pandemic, all travel and in-person meetings are suspended at this time.
How To Apply
If you have the required qualifications and would like to become a member of our team, please submit your resume by 4PM on Monday, April 26, 2021.
No phone calls please. We thank all interested individuals, but only those candidates being considered for an interview will be contacted. ASEBP is an equal opportunity employer.
All offers of employment for this position are conditional upon satisfactory background and reference checks, which may include a criminal record check, and/or education and employment verification.