Spécialiste En Gestion D’invalidité

Montréal, QC, CA, Canada

Job Description

Le role de Specialiste en gestion de l'invalidite est charge de gerer les demandes d'invalidite quotidiennes (ICD / ILD / mesures d'accommodement) des clients, d'aider a faciliter le retablissement et de promouvoir le retour au travail rapide et securitaire des employes travaillant pour les clients. Ils vivent selon les valeurs d'OSI de retour au travail et de retablissement. Les Specialistes en gestion de l'invalidite communiqueront avec les principaux intervenants afin de juger, de gerer, de planifier le retour au travail et de faire les rapports. Soutenir le Coordonnateur en gestion de l'invalidite (CGI) et l'Evaluateur des capacites (EC) sur les dossiers complexes. Conjointement a l'execution du reglement des reclamations, de la gestion des reclamations et du retour au travail. Le Specialiste en gestion de l'invalidite evaluera egalement les performances historiques des reclamations et travaillera en collaboration avec notre equipe pour fournir des programmes axes sur les solutions et developper les meilleures pratiques pour la gestion des reclamations et des soins, pour les clients actuels et les nouveaux clients. Etablir et entretenir des relations positives avec les clients. Fournir des rapports trimestriels et annuels axes sur l'amelioration continue.

Taches et responsabilites principales:



- Gerer toutes les reclamations conformement aux politiques du client et d'OSI
- Entrer des informations detaillees dans Orgsys
- Gerer toutes les reclamations avec un focus sur le retour au travail et sur la duree la plus courte
- Facilitater le retour au travail, dans les meilleurs delais
- Travailler au sein d'une equipe interne et externe avec le client
- Partenariat avec le client pour comprendre le lieu de travail
- Avoir un impact d'amelioration continue
- Gerer toutes les reclamations avec un haut degre d'excellence
- Gerer toutes les reclamations complexes, y compris, mais sans s'y limiter, les reclamations psychologiques
- Evaluer les informations medicales et reliees au travail pour determiner si des elements cles sont presents
- Explorer des technologies innovantes pour reduire les durees, i.e. la cognabilite, la pharmacogenetique
- Elaborer des plans de retablissement et de retour au travail axes sur les resultats
- Communiquer les capacites fonctionnelles de l'employe a l'employeur pour determiner si l'employeur est en mesure de fournir des taches modifiees dans la planification du retour au travail
- Faciliter le retour au travail de maniere coherente avec un plan de retour au travail transitoire (PRTT)
- Finaliser les rapports annuels a presenter au client
- Encadrer d'autres membres du personnel de gestion de l'invalidite en ameliorant leurs connaissances et leurs niveaux d'education
- Determiner quand des outils supplementaires doivent etre utilises aux moments appropries (ex: IME / FCE, se referer a la reeducation, au medecin traitant, a la pharmacogenetique ou aux evaluations du poste de travail, etc.)
- S'assurer que l'employe recoit en tout temps un traitement optimal
- Faciliter le plan de traitement avec le medecin traitant et / ou le specialiste
- Mener des entrevues fonctionnelles telephoniques detaillees concernant les activites de la vie quotidienne (AVQ) tout en fournissant des conseils pour reduire les obstacles
- Interagir avec les autres pour ameliorer les resultats
- Fournir un soutien aux EC, CGI et des conseils sur les specificites du client et le processus / protocole de decision
- Etre conscient du statut des reclamations a tout moment, garantissant que Orgsys est entierement mis a jour
- Fournir des strategies solides pour reduire la duree des reclamations
- Organiser et participer aux appels et reunions mensuels avec les clients
- Remue-meninges avec le chef d'equipe sur toute reclamation de plus de 30 jours
- Calculer et communiquer a l'employe et au client, le montant du paiement des prestations sur leurs demandes approuvees, pour chaque periode de paie pertinente, a verser par le client ou OSI (specifique au client)
- Surveiller les plans de retour progressif au travail
- Faire le suivi de toute action ou information de reclamation manquante
- Veiller a ce que les commentaires signales soient mis a jour au moins une fois par semaine
- Examiner les rapports mensuels
- Agir en tant que responsable client sur les comptes non RC
- Examiner et fournir un rapport annuel et / ou trimestriel, la ou aucun responsable client n'est en place, avec un objectif d'amelioration positive et continue
- Travailler en collaboration au sein de l'equipe client
- Participer a des remue-meninges et des comites pour faire progresser OSI, c'est-a-dire formation, comite social, etc.
- Etablir des objectifs individuels conformes a l'orientation organisationnelle et aux donnees livrables au client

Competences requises :



- Titre professionnel enregistre / certification ou en cours d'obtention est un atout: (IA, IAA, parent, RRP ou autre experience en sante; Praticien certifie en gestion d'invalidite / Coordonnateur de retour au travail agree)
- Experience pertinente en gestion de l'invalidite / Reglement des reclamations / Initiatives de retour au travail / Gestion des reclamations ICD et ILD
- Excellente comprehension des problemes de sante mentale, du traitement et du retour au travail
- Excellentes competences en negociation
- Pensee critique et raisonnement analytique
- Sens aigu de l'urgence et competences d'organisation / de priorisation
- Excellentes competences en service a la clientele et en communication
- Capable de travailler en tant que membre cle d'une equipe ainsi que de maniere independante
- Capacite a travailler selon les procedures et politiques etablies pour garantir que les protocoles de confidentialite et les procedures d'exploitation sont respectes a tout moment
- Excellentes competences dans les suites Microsoft Office, et capacite a apprendre un systeme de base de donnees interne
- Respect de la politique de l'entreprise, c'est-a-dire pas de potins, sante et securite, etc.
- Amelioration continue

Conditions de travail :



- Environnement de bureau
- Capacite a s'asseoir pendant de longues periodes.
- Deplacements occasionnels chez les clients au besoin - moins de 5%

Relations hierarchiques :



- Imputable envers le chef d'equipe designe
- Entreprise autogeree, responsable vis-a-vis des mesures de rendement cle (MRC) et des objectifs

Overview / General Purpose:



The Disability Management Specialist role is responsible for managing the day to day disability claims (STD / LTD / Accommodations) for clients, assist in facilitating recovery, and promoting early and safe return-to-work for clients' employees. They live to OSI's values of return to work and recovery. Disability Management Specialists will communicate with key stakeholders in order to adjudicate, manage, return-to-work planning, and reporting. Support Disability Management Coordinator (DMC) and Abilities Assessor (AA) on complicated files. In conjunction with the performance of claims adjudication, claims management, and return to work. The Disability Management Specialist will also evaluate historic claims performance and work collaboratively with our team to provide solution-focused programs, and develop best practices for claims and care management, for ongoing and new clients. Establish and maintain positive client relationships. Deliver quarterly and annual reports with continuous improvement focus.

Primary Duties and Responsibilities:



Adjudication of all claims in accordance with client and OSI policies

Enter detailed info into Orgsys

Manage all claims with a RTW focus and for the lowest duration

Facilitation of return to work, as soon as possible

Work as part of a team internal and externally with client

Partner with client to understand workplace

Provide continuous improvement impact

Manage all claims with a high degree of excellence

Manage all complicated claims including but not limited to psychological claims

Evaluate medical and workplace information to determine if key elements are present

Explore innovative technologies to reduce durations, i.e. cognability, pharmacogenetics

Develop outcome focused recovery and RTW plans

Communicate the employee's functional capabilities to the employer to determine if the employer is able to provide modified duties in the return to work planning

Facilitate RTW consistently with a Transitional Return to Work Plans (TRTWP)

Finalize annual reports to be presented to client

Coach and mentor other disability management staff by enhancing their knowledge and education levels

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.)

Ensure the employee is receiving optimal treatment at all times

Facilitate treatment plan with treating physician and / or specialist

Conduct detailed phone functional interviews regarding activities of daily living (ADL) while providing tips to reduce barriers

Interact with other to enhance claim outcomes

Provide support to AA, DMC, and guidance on client specifics and decision process / protocol

Aware of status on claims at all times, ensuring Orgsys is fully updated

Provide strong strategies to reduce claim duration

Organize and participate in monthly client calls and meetings

Brainstorm with Team Lead on any claims over 30 days

Calculate and communicate benefit payment amount for specific clients on their approved claims for each relevant pay period to both the employee and the employer to be paid out by the client or OSI

Monitor the progressive return to work plans

Follow up with any missing claim actions or information

Ensure reported comments updated at least weekly

Review monthly reports

Act as Client Lead on non CL accounts

Review and deliver annual and/or quarterly report, where no Client Lead is in place, with positive and continuous improvement focus

Work collaboratively as part of client team

Participate in brainstorming and committees to advance OSI, i.e. training, social committee, etc.

Establish individual goals consistent with organizational focus and client deliverables

Required Competencies:



Registered professional designation / certification or working towards is an asset: (RN, RPN, Kin., RRP or other related healthcare background; Certified Disability Management Practitioner / Certified Return to Work Coordinator

Relevant experience in Disability Management / Claims Adjudication / Return-To-Work Initiatives / STD and LTD Claims Management

Solid understanding of mental health conditions, treatment, and return to work

Strong negotiation skills

Critical Thinking Skills, analytical reasoning

High sense of urgency and organization / prioritization skills

Excellent Customer Service and communication skills

Able to work as a key member of a team as well as independently

Ability to work within set procedure and policy to ensure the privacy protocols and standard operating procedures are adhered to at all times

Strong proficiency and skills in the Microsoft Office Suites, and have the ability to learn an internal database system

Abide by company policy, i.e. no gossip, Health & Safety, etc.

Pursuit of mastering

Working Conditions:



Office environment.

Ability to sit for prolonged periods of time.

Occasional travel to client locations when needed - Less than 5%

Reporting Relationship:



Accountable to assigned Team Lead

Self-managed company, accountable to KPM's and goals

Job Type: Full-time

OSI is committed to gender equality and social inclusion in our workplace. All qualified applications will receive consideration without regard to sex, gender identity, gender expression, sexual orientation, race, ethnic origin, color, religion, nationality, disability, age, or any other characteristic protected by applicable law. We encourage all qualified persons to apply particularly Indigenous peoples, persons with disabilities, ethnic minorities, visible minorities, and others who share our values and contribute to fostering an inclusive and diverse workplace.

Organizational Solutions Inc. is committed to fair and accessible employment practices.

We will accommodate people with disabilities during the recruitment, assessment, hiring processes, and employment. Please notify us as soon as possible of any adaptive measures you might require at any stage of the recruitment process.

Job Types: Full-time, Permanent

Benefits:

Casual dress Company events Dental care Disability insurance Employee assistance program Extended health care Flexible schedule Life insurance On-site parking Paid time off RRSP match Tuition reimbursement Vision care Work from home
Work Location: Hybrid remote in Montreal, QC H3C 1E2

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Job Detail

  • Job Id
    JD2764821
  • Industry
    Not mentioned
  • Total Positions
    1
  • Job Type:
    Full Time
  • Salary:
    Not mentioned
  • Employment Status
    Permanent
  • Job Location
    Montréal, QC, CA, Canada
  • Education
    Not mentioned