[Hiring] Claims Specialist @Disability Management Institute

Role Description

The Claims Specialist will provide case management expertise and coaching support for the insured block of disability claims, performing strategic case reviews and audits to identify trends and opportunities. As a member of the Practice & Excellence Team, the Claims Specialist will partner with the Quality, Training, Rehab, and Claims teams to develop strategies that drive quality performance and support business initiatives. The Claims Specialist will also serve as a subject matter expert in holistic disability case management, vocational rehab application, and risk mitigation strategies. This is a remote role within Canada. We are open to candidates across the country, however you must work within our core business hours.

• Conduct in-depth file reviews with a quality assurance lens, focusing on resolution and enhanced case management opportunities while assessing trends, strengths, and areas for development.
• Use metrics reporting, client feedback, file reviews, and financial reporting to evaluate client performance, and incorporate benchmarks into quality programs based on service level requirements.
• Consult on complex disability claims, appeals, and policy wording interpretation.
• Apply claims litigation experience to complex file reviews, appeals, and litigated claims, partnering with leadership and legal counsel to develop case strategies, mitigate risk, and support resolution outcomes.
• Partner with business unit leaders to identify priority complex claims, including litigated files, and document creative case strategies, intended outcomes, and next steps.
• Prepare and present Alternate Resolutions to plan members and their employers.
• Review previous appeal and litigation cases for trends, training or process gaps, and consult on mitigation strategies with the leadership team.
• Identify claims to Management with potential for rehab utilization, media threats, legal involvement, or settlement interest.
• Act as a subject matter expert for all components of the claims process, including Benefit Calculations, WEBS entries and corrections, and DMS documentation.
• Provide coaching and support to File Owners on disability management matters, including creative strategies for complex files and the review of agreed case plan outcomes.
• Share best practices and coach on partnering with Employers, including collaborative communication, alignment on case objectives, and creative approaches to support recovery, rehabilitation, and return to work outcomes.
• Facilitate shared learning from complex claims, litigation, and project outcomes, translating lessons into practical approaches for the teams.
• Oversee quality control and coaching with Business Units, including new hire support and ongoing coaching.
• Develop and implement action plans with business unit leaders to support team members in progressing from QC 1 to QC 4 competency.
• Identify and report disability management trends or risks, and work with the Training team and business unit leaders to develop coaching and training plans.
• Create and maintain process and procedure reference material for claims case management and litigated and non-litigated alternate resolutions.
• Work with Managers, Supervisors, Senior CMs, and the Training and Quality Units to ensure processes, procedures, templates, and forms are updated and implemented as business needs evolve.
• Lead and support strategic and transformation projects, including industry best practices related to a holistic model, defining deliverables, milestones, and outcomes and reporting on progress, barriers, and results.
• Collaborate with internal and external stakeholders to build consensus and support strategic initiatives.
• Manage a partial disability caseload, complex files, or client relationships as business needs require.
• Act as a second or third level of escalation for concerns and issues, such as appeals.

Qualifications

• 10+ years of experience in injury, recovery, disability, and rehabilitation management.
• Experience conducting quality audits or reviews for an insurer, or equivalent experience and transferable skills.
• Demonstrated claims litigation experience, including complex or litigated disability claims and collaboration with legal counsel on case strategy and resolution.
• Experience developing and delivering training and coaching material.
• Experience working within cross-functional project teams and driving projects to completion with defined deliverables and outcomes.
• Experience coaching and sharing learning with colleagues on creative strategies for complex files and best practices for partnering with Employers.
• High attention to detail and strong analytical and problem solving skills to build targeted, proactive plans.
• Strong verbal and written communication skills in English.
• Sound computer skills, including Microsoft Outlook, Word, Excel, and PowerPoint.
• Ability to work independently and within an integrated team, adapt to rapidly changing circumstances, and meet tight deadlines under pressure.
• A post secondary degree in health sciences or a related field is considered an asset.
• Good standing with a regulatory body in a health, rehabilitation, or related field is considered an asset.

Compensation

At the time of this posting, the estimated annual base salary for this position is $85,000-$95,000. Individual compensation within this range is determined by factors such as job-related skills, relevant experience, and education/training. This range reflects the annual base salary only and does not encompass the comprehensive total rewards package that we proudly offer.

Benefits

• Generous paid time off including 3 weeks minimum vacation, plus 26 long weekends a year through our much-loved Happy Friday program.
• Flexible work options including remote and hybrid schedules.
• Extended health and dental benefits.
• RRSP matching.
• Wellness support, including comprehensive mental health resources.
• Clear career paths, personalized learning, and leadership committed to invest in your development.

Company Description

Diversity, inclusion, and belonging aren’t just programs at DMI; they are our foundation. We foster a safe, respectful, and inclusive workplace where everyone belongs and can thrive.