Disability Case Administrator (Acting)

Summary of Duties

• Review and analyze medical information received and adjudicate claims ensuring legislative compliance and adherence to collective agreements, terms and conditions, related policies, procedures, practices and guidelines.
• Identify cases requiring further medical management and arrange/facilitate for medical examinations and other health evaluations (e.g., IME’s, rehabilitation services,).
• Follow up with claimants to ensure appropriate information is received to adjudicate claim.
• Request additional information from the treating physician, where necessary.
• Work closely with various stakeholders to ensure effective early intervention.
• Maintain regular contact with employee and various stakeholders throughout the disability management process.
• Analyze restrictions and limitations and ensure appropriate plans are in place to address the same.
• Liaise with medical providers to ensure effective and timely return to work and appropriate rehabilitative plans are implemented that will enable successful re-entry of employees into the workplace.
• Facilitate the seamless transition of employees transferring to Long Term Disability and returning from LTD.
• Enter and update claims information on disability claim management system (e.g., Parklane).
• Escalate complex cases to the Manager, Disability Case Management, as required.
• Ensure disability and WSIB claims are processed in timely manner including providing claimants with appropriate information.
• Communicate claims information and decisions to appropriate stakeholders, as required.
• Maintain confidentiality of all medical records and documentation.
• Provide interpretation, advice, guidance and assistance to employees regarding the short-term disability management program, WSIB and EAP.
• Develop timely, safe, and effective return to work plan and strategies in conjunction with employees, managers/supervisors, union/federation.
• Facilitate return to work through various strategies, which may include site visits, as required.
• Deliver training programs and communication strategies as required.
• Attend and participate in meetings including committees and workgroups.
• Liaise with various stakeholders as required.
• Provide support for grievances/arbitrations/hearings, WSIB appeals and tribunals, and represent the Board where required.
• Assist with the preparation of submissions for grievances/arbitrations/hearings, WSIB appeals and tribunals.
• Review and analyze reports (e.g., absence reports) to determine trends, appropriate course of action and interventions required and provide information to others as needed.
• Monitor and review absence information (e.g., consecutive absence reports) and ensure appropriate adjustments are made to sick leave allotment, vacation and miscellaneous quotas.
• Monitor return to work and ensure quota allotments are adjusted further, as needed.
• Respond to inquiries regarding related entitlements as per Collective Agreement requirements and Terms and Conditions.
• Other duties as assigned.

Qualifications

• University degree in a related field such as Health Sciences (e.g., Bachelor of Health Sciences, Occupational Health Nurse, Rehabilitation Services) and three years of related experience in disability case management in a large, unionized organization, or equivalent combination of education and experience.
• Demonstrated training and experience in claims adjudication and claims management, rehabilitative employment, modified return-to-work and accommodations.
• Knowledge of WSIA, Occupational Health and Safety Act, Human Rights Code, Municipal Freedom of Information and Protection of Privacy Act and other related legislation.
• Knowledge of related Board policies, procedures, protocols and collective agreement provisions.
• Discretion, judgment and ability to deal with highly confidential information, sensitive and emotional situations.
• Conflict resolution/mediation skills.
• Strong analytical/interpretative and problem-solving skills.
• Strong organizational and time management skills.
• Strong written, oral and interpersonal communication skills including presentation skills and facilitation skills.
• Proven ability to work collaboratively in a team environment.
• Proven ability in promoting equitable practices which value inclusiveness and diversity.
• Computer skills including spreadsheets, databases, word-processing, disability management software, human resources/payroll information system and presentation packages.

Special Requirements

• May require occasional travel to TDSB sites.

Asset