OverviewPacific Blue Cross Disability Adjudication Specialist – Permanent Full Time in Burnaby, BC
Pacific Blue Cross
Branch Burnaby BC CA
Disability Adjudication Specialist – Permanent
Medical and Pharmaceutical Concepts. Minimum of two years previous related experience, including at least one year in a Disability Claims Administrator or…
Pacific Blue Cross has been British Columbia’s leading benefits provider for 75 years. We are an independent, not-for-profit society with strong roots in BC’s health care system. Together with our subsidiary BC Life, we provide health, dental, life, disability and travel coverage for approximately 1.5 million British Columbians through employee group plans and through individual plans for those who do not have coverage with their employers.
We are fueled by a commitment to keep health care sustainable for all British Columbians. Through our Community Connection Health Foundation, we also provide funding to community organizations with a focus on alleviating mental illness and chronic disease. We’re interested in finding people who want to make a difference and who will take advantage of every opportunity to build a career with us.
Pacific Blue Cross offers an attractive compensation and benefits package, fitness programs, and an onsite gym and cafeteria. Our workplace culture values health and wellness, continuing education, environmental sustainability and giving back to the community.
We are currently recruiting for a permanent full-time Disability Adjudication Specialist to join our BC Life Claims team.
BC Life Disability Claims Adjudication and Assessment
o Provides professional disability claims services to insured clients and ensure claims are coordinated within contractual terms and conditions of eligibility and coverage by:
organizing, reviewing, analyzing and investigating claims and eligibility information from a variety of sources;
interpreting and applying contract wording, medical reports, claims policies and procedures, statutory requirements and other guidelines affecting valuation and disposition of short and long term disability claims;
investigating pre-existing limitations to determine impact on eligibility and valuation;
interviewing claimants, policy-holders, employers, doctors, lawyers, brokers, third parties and other stakeholders in the disability claims process to verify claims information, determine status of accommodation and return to work, and identify the potential for current and future intervention and case management services;
planning the content of and composing a variety of written correspondence and reports which adhere to the established standards of business English and internal style guidelines;
initiating referrals or escalation to other internal or external disability resources where intervention or case management is required;
adjudicating claims where intervention is not required, including keying claims data into claims processing systems and documenting all contacts made and actions taken;
following up on third party claims and calculating amounts owing based on policy provisions;
conducting annual reviews of maintenance claims to determine status and initiate any required action where status has changed including calculating cost of living increases.
Customer, Client and Member Service
o Staffs the department’s incoming phone queue by receiving, screening and responding to general and specific claims inquiries from external contacts.
General Team and Department Support
o Tracks statistical information on claims activities to monitor productivity and adherence to department service level objectives by entering or updating data on existing spreadsheets or checklists.
o Maintains up to date knowledge of disability management practices, policies and procedures, system requirements and other information related to the provision of disability management services through continuous learning initiatives.
o On a one to one basis, supports new employees by demonstrating the execution of specific tasks and duties, and sharing knowledge and experience on request.
o Performs other assigned duties related to the provision of disability claims, adjudication and administrative support services which do not affect the rating of the job.
High school graduation or equivalent
Completion of 50% of the requirements leading to a Certificate in Disability Management (Grant MacEwan College: 15 credits or 225 hours) including:
DMWP 100 Essential Anatomy and Physiology
DMWP 102: Medical and Pharmaceutical Concepts
DMWP 104: Introduction to Disability Management
ENGL 111: Communications
INTD 105: Interpersonal Skills Development
Minimum of two years previous related experience, including at least one year in a Disability Claims Administrator or Benefit Representative position (or equivalent)
Demonstrated proficiency in Basic Word
Minimum typing skills of 40 wpm
Demonstrated decision making skills
Demonstrated oral/written communication skills
Please apply online via our website: http://www.pac.bluecross.ca/company/careers/
While we thank all candidates for their interest, only shortlisted candidates will be contacted.
Employment Type: Full Time
Location: Burnaby, BC, CA
Posted on: 2015-05-22