Job Description: Use a proactive case management approach to make and communicate eligibility decision on benefits and services in a timely fashion that are consistent with relevant WSIB policy. Address worker and employer needs by actively listening, collecting and proving relevant information, and helping the workplace parties understand their rights, responsibilities and obligations. Manage cases that are allowed, denied, reconsidered or resolved within established program guidelines, following a structured case management framework to enable them to achieve high quality eligibility decisions and successful outcomes. Job Responsibilities: Inform parties of their rights, responsibilities and obligations under the WSI Act and applicable legislation, and the consequences of non-compliance. Proactively collect information from workplace parties and healthcare providers required for eligibility decisions and respond to inquiries. Assess case and plan towards best outcomes. Make eligibility decisions quickly and accurately and communicate them, verbally and in writing by determining the following: The employer is covered under the Act; The worker is employed by the employer at the time of the injury; The injury is work-related; Proof of accident can be established; The diagnosis is compatible with the accident; Continuity and compatibility support ongoing entitlement in the case of recurrence; Ensuring accident reporting compliance with the employer. Support workplace parties in their return to work (RTW) efforts by sharing any available information about the workers' capabilities and/or precautions. With the assistance of Payment Specialists where required, ensure appropriate earnings information is on file in order to determine the appropriate duration and level of benefits. Review and monitor cases until closure or transition to a Case Manager, assessing RTW and recovery factors to differentiate cases requiring Case Manager expertise. Refer requests to appropriate internal WSIB parties (Nurse Consultant, Account Specialist, Legal Services) to gain their expertise on various components of a claim when the need for appropriate intervention is recognized and follow up with them as required. Attempt to prevent or resolve disputes, handle requests for reconsideration and, if unresolved, arrange access and process the objection. Perform other related duties as assigned or required such as participation in the development and implementation of business plans and projects. Job Requirements: University completion at undergraduate level. Two years prior experience in adjudication and customer service. Job Details: Company: OPS Vacancy Type: Full Time Job Location: Ottawa, CA Application Deadline: N/A Apply Here getyourvacancy.com
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