The WCS role is responsible for managing the day-to-day Workers’ Compensation (WC) claims for ongoing and new clients ensuring no lost time, recovery and return to work. Claims management includes strong return to work and no lost time strategies, appeals and analysis of data for ongoing and continuous improvement. The WCS is involved in the maintenance and development of practices and procedures for claims and disability management services. The WCS will communicate with key stakeholders involved in order to manage return-to-work planning and mitigate lost time. The WCS manages the claim, evaluates historical claim performance, confirms treatment programs with the healthcare provider, and liaises with all stakeholders to provide solution-focused programs that are entered into the internal management system and follow best practices for claim and care management. Establish and maintain positive client relationships. Deliver quarterly and annual reports with continuous improvement focus.

The Workers’ Compensation Specialist will:

• Manage all aspects of WC claims.
• Develop goal oriented, proactive case management, and return to work strategies.
• Coordinate the return to work process; reviewing functional capabilities, overseeing modified work programs, monitoring claims for areas of objection, formulating objections and/or appeals and following through to the appropriate level.
• Enter all information into the internal management system.
• Follow up or direct follow up with any missing claim actions or information.
• Dispute claims, where appropriate.
• Manage and prepare files for appeals.
• Attend appeals, as appropriate.
• Evaluate medical information, determine if key elements are present, and develop case management strategies for recovery.
• Develop outcome focused RTW plans.
• Finalize, review, and deliver quarterly and/or annual reports to be presented to client.
• Coach and mentor other WC disability management staff by enhancing their knowledge and education levels.
• Mentor and monitor junior staff to ensure KPM delivery.
• Partner with clients to understand workplace, workplace issues, and prevention strategies.
• Work collaboratively as part of a team with a Client Lead (if applicable).
• Conduct detailed phone interviews, while providing tips to remove barriers.
• Ensure the employee is receiving optimal treatment at all times.
• Explore innovative strategies to reduce duration and increase immediate and successful RTW outcomes.
• Provide support and guidance on client specifics and decision process and protocol.
• Aggressively manage and provide strong strategies to eliminate lost time.
• Determine when additional tools are to be used at the appropriate times (i.e.: IME / FCE, refer to rehabilitation, medical consultant, pharmacogenetics, or workstation evaluations etc.)
• Be aware of current claim status at all times with proactive follow ups.
• Organize and participate in monthly client calls and meetings with full claim updates and next steps prepared in advance.
• Calculate and communicate WC premium and experience rating projections, and claim impact on claim costs.
• Review Monthly Reports – Highlight any Lost-Time claims. Develop, be aware, and monitor action plans on Lost-Time claims.
• Ensure DMA has submitted F7 on time, monitoring and secondary accident cost, apply for cost relief on applicable files, requesting experience rating statements.
• Ensure customer satisfaction.
• Ensure reported comments updated at least once a week.
• Interact with others to enhance continuous improvement outcomes.
• Act as Client Lead on non-CL accounts.
• Strategize with Team Lead on any claims over 30 days.
• Ensure client experience rating is documented and reported to the client.
• Appropriately represents OSI at meetings, events, and speaking engagements.
• Participate in strategizing and committees to advance OSI, i.e. training, social committee, etc.
• Establish individual goals consistent with organizational focus and client deliverables.

To be successful as the Workers’ Compensation Specialist with OSI, you will need:

• Registered professional designation (e.g., Paralegal, CDMP, CRTWC) or working toward certification.
• Relevant experience in Workers’ Compensation case management, return-to-work programs, WCB appeals, NEER rating experience.
• High level knowledge of WC legislation, operational policy, and experience rating.
• A healthy view and understanding of mental health.
• Understanding of musculoskeletal and mental health conditions.
• Understanding of musculoskeletal system and healthcare approaches.
• Strong proficiency and skills in the Microsoft Office Suites.
• Analytical and critical thinking skills with strong decision-making skills.
• Resiliency, flexibility, innovation, and initiative by adapting to change and proactively solving challenges.
• Effective communication and negotiation skills with a client-focused mindset.
• To be a team player with the ability to work independently, while following policies, procedures, and maintaining confidentiality.
• To be tech-savvy and performance-driven, with proficiency in Microsoft Office and a commitment to continuous learning and meeting KPIs.

All-star candidates will have:

• Completion of the Mental Health First Aid Course is considered an asset
• Completion of the Applied Suicide Intervention Skills Training Course is considered an asset.

Organizational Solutions Inc. (OSI) is a premier provider of short-term disability claims management, leave administration, and workers’ compensation claims management in Canada. With over 21 years of experience, OSI is dedicated to delivering personalized support and optimizing workplace health and productivity.

Providing an inclusive, accessible environment, where all employees and clients feel valued, respected and supported is something we’re committed to. We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee has the opportunity to reach their potential. If you require an accommodation or an alternative format of any posting please reach out to careers@peoplecorporation.com.