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Claims Adjudicator (J.O#10723ie)


Job Opportunity Program
Toronto, Ontario
Posted On: May 14, 2018
Last Day to Apply: May 18, 2018
Employment Type: Full Time

CLAIMS ADJUDICATOR

OHCM SECTION, HUMAN RESOURCES DEPARTMENT

 

The Toronto Transit Commission (TTC) is North America’s third largest transit system and has been recognized as one of the top places to work in the GTA. Guided by a forward-thinking strategic plan, the TTC’s vision is to be a transit system that makes Toronto proud. The TTC’s recruitment efforts are directly aligned to its mission of providing “a reliable, efficient, and integrated bus, streetcar, and subway system that draws its high standards of customer care from our rich traditions of safety, service, and courtesy.”

We are currently seeking a Claims Adjudicator.

KEY ACCOUNTABILITIES

  • Adjudicates and processes WSIB claims in accordance with established policies, procedures and the Workplace Safety & Insurance Act; determining eligible claims for WSIB submission; inputting and maintaining claim information; investigating claim/claimant history; completing, verifying and submitting Employer Reports; and managing the claim files
  • Adjudicates and processes Short Term Disability claims in accordance with established policies and procedures, applicable collective agreements and the Disability Claims Management Team Guidelines; determining claim eligibility; advising employees regarding denials; ensuring processing/payment of eligible claims within weekly deadlines; managing claim files; and inputting, monitoring and updating claim information into the appropriate database system
  • Provides assistance and responds to inquiries; communicates with staff, hourly-rated employees, supervisors/ management, union representatives and doctors regarding claim status, payment of benefits/denied claims; forwards information to the Disability Management Specialist for complex cases; and prepares a variety of correspondence, reports, statistics and other materials
  • Participation in the TTC customer service Ambassador Program
  • Responsible for treating passengers and employees with respect and dignity and ensuring the needs of passengers or employees with disabilities are accommodated and/or addressed (within their area of responsibility) in accordance with the Ontario Human Rights Code and Related Orders so that they can fully benefit from the TTC as a service-provider and an employer

SKILLS, KNOWLEDGE & EXPERIENCE

  • Good knowledge of employee benefit administration practices and claims management, assessment and review procedures; and familiarity with medical terminology, including diagnosis, treatment plans and symptoms
  • Must have or quickly develop knowledge of claims adjudication principles including short-term disability, the Workplace Safety & Insurance Act, and administrative practices and procedures inherent to WSIB and claims administration/adjudication
  • Knowledge of health protection legislation (PHIPA) for the use and disclosure of medical information
  • Sound knowledge of modern office administration, practices, procedures and equipment
  • Sound judgement; good interpersonal and effective oral and written communication skills to deal with a variety of contacts; and good organizational skills to prioritize work and meet established deadlines
  • Proficient in the use of PCs and software applications related to the work (Word, Excel, databases, Parklane system, etc.)
  • Good keyboarding skills and attention to detail for accurate transferring of information from a variety of correspondence
  • University Degree or College Diploma in a related discipline and relevant work experience in administration of income replacement plans/programs, claims assessment/adjudication, monitoring and investigation, or a combination of education, training and experience deemed to be equivalent
  • Must have or quickly develop knowledge of TTC/departmental structure, policies, procedures and relevant sections of the Collective Agreements applicable to the work performed as well as a working knowledge of policies, procedures, programs and initiatives relating to Occupational Health Services (Employment Insurance, CPP, etc.)
  • Must have or rapidly acquire a comprehensive knowledge of the Ontario Human Rights Code and Related Orders including disability accommodation and accessibility requirements pertaining to passengers and employees

Annual Salary Range: $64,082.20 - $80,116.40 (Level 7SA) – 35 Hour Work Week

At the Toronto Transit Commission (TTC), we place a high value on establishing a workplace where people are challenged and respected every day, and we keep Toronto moving with a dedication to service, safety and convenience that is unparalleled in our industry. We invite you to join our team in delivering on our commitment to creating a transit system that makes Toronto proud.

Hiring and selection preferences are not given in the employment of an employee’s relatives. Relatives of current TTC employees cannot be hired, assigned transferred or promoted into positions, where there is a potential conflict of interest due to relationship. If you are qualified for the position for which you are applying, you will be required to disclose the name, relationship, and position of any relative who is a current TTC employee at the employment interview.

The TTC is committed to fostering a positive workplace culture with a workforce that is representative of the communities it serves. Committed to the principles of diversity and inclusion, the TTC encourages applications from all qualified applicants. Accommodation is available for applicants, including those with disabilities, throughout the recruitment process. Please contact Human Resource- Employment Services at (416) 393-4570.

 

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