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Medavie

Nonprofit health insurance and care group

Disability Claims Specialist

Claims AdjudicationPosted on Nov 9
Full-timeNova Scotia, Canada

About the Job

Requirements

  • A university degree or completed college diploma is required; related fields such as occupational health, disability management, kinesiology, education, human resources, or legal studies are assets but are not limiting.
  • Relevant work experience in disability claims management or insurance benefits case management, including assessing eligibility and managing an active caseload.
  • Demonstrated experience making and communicating complex case decisions, managing competing priorities independently, and guiding clients through difficult situations.
  • Proficiency with Microsoft Office applications, including Word, Excel, and Outlook.
  • Ability to navigate multiple software applications simultaneously while maintaining detailed online notes and tracking information.
  • Strong written and oral communication, organizational, and prioritization skills.
  • Experience providing customer care, support, and assistance, including clearly communicating complex and difficult information.
  • Ability to improve operational efficiency, influence change, and focus on client needs.
  • Strong initiative, strategic thinking, and problem-solving, with the ability to work independently and with all organizational levels.
  • Ability to maintain a high degree of accuracy in a fast-paced environment.

Responsibilities

  • Adjudicate disability claims from the initial decision through development of an appropriate case management plan, identifying required supports, monitoring treatment and plan progress, and working with claimants, employers, and involved providers.
  • Actively manage files by communicating regularly with stakeholders, assessing the use of claims tools such as rehabilitation, and requesting ongoing medical information as needed.
  • Assess key dates throughout the claim lifecycle and regularly update case management plans.
  • Ensure required tasks within the assigned caseload meet service-level standards.
  • Make timely, potentially difficult decisions and communicate them effectively while managing escalations with employers and claimants.
  • Build effective relationships with claimants, treatment providers and physicians, employers, group administrators, human resources, and lawyers to support recovery and return to work.
  • Use the electronic case management system effectively and consistently.

Desired Qualifications

  • Experience reviewing contracts, medical documentation, and reports to assess claims, support decisions, and develop case management plans.
  • Related education in occupational health, disability management, kinesiology, education, human resources, or legal studies.

About the Company

Medavie

Nonprofit health insurance and care group

Medavie is a nonprofit Canadian health group that combines insurance and healthcare services for individuals, employers and governments. Its Medavie Blue Cross business sells health, dental, travel, life and disability coverage, while Medavie Health Services operates emergency response and community care programs. The group also administers public health benefits, processes claims and trains paramedics through Medavie HealthEd. Its care teams work in homes and communities as well as through ground and air ambulance services, and it reinvests in its operations and community health initiatives. Medavie traces its roots to 1943 and is headquartered in Dartmouth, Nova Scotia.

Company size
Not listed
Company stage
Not listed
Total funding
Not listed
Headquarters
Dartmouth, Canada
Founded
1943

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