WSIB Claims Consultant

WSIB Claims Consultant

Department:
Occupational Health, Safety & Wellness

Hours of Work:
Full-Time Position

Salary:
Class 05 - $84,691-$101,629 per annum + pension/benefits

Union:
Non-Union

Location:
Kingston General Hospital Site

About the Role

The overall goal of the position is to avoid and reduce WSIB claim costs for control of the KHSC's WSIB premiums through claims management activities on KHSC WSIB files (Note - this position has no involvement with case managing injured workers or setting up return to work plans).

The claims management activities that are central to this role are focused on:

• Preparing submissions to the WSIB, on behalf of the employer, where appropriate, related to claim entitlement.
• Preparing cost relief submissions to the WSIB, on behalf of the employer, and under the Secondary Injury Enhancement Fund (SIEF).
• Pursuing WSIB denials through the Appeal's Resolution Office and Workplace Safety & Insurance Appeals Tribunal (WSIAT).
• Overseeing WSIB claim costs and rate framework statements to identify WSIB errors for their correction.
• Analysing claims costs to forecast WSIB premium rates.
• Developing process documents and templates to improve role efficiency, effectiveness, and build capacity of others (e.g., RTW Specialists) to assist with submissions when needed.
• Interpreting and assessing existing Board policy and changes in WSIB legislation and policy to identify new strategies.

Responsibilities

Weighing all available information against relevant WSIB law, policy, and guidelines to identify areas of concern regarding claim entitlement/WSIB benefits and preparing clear, thorough, and accurate correspondence and submissions to the WSIB, as necessary.

Reviewing all approved WSIB claim files against the Board's Secondary Injury Enhancement Fund (SIEF) policies to determine whether there is merit in the case to request SIEF cost relief.
Where indicated, preparing clear, thorough, and accurate submissions using medical evidence and accident information on file, along with relevant WSIB law and policy, Workplace Safety & Insurance Appeal Tribunal (WSIAT) Decisions, and other relevant information to substantiate the employer's request for SIEF.

Assessing all claim decisions to determine whether an appeal of the decision is appropriate, in which case, preparing all objection and appeal forms (e.g.
Notice of Appeal form, Readiness Form, Confirmation of Appeal form, etc.) and written submissions and evidence to the Appeals Resolution Office (ARO) and then to WSIAT if necessary by required deadlines.
Representing the employer at in-person hearings at the ARO and WSIAT as needed.

Reviewing all individual claim-related correspondence from the WSIB, as well as all employer premium statements, financial statements, and monthly cost statements, via the WSIB electronic portal and hard copy correspondence, to ensure accuracy (e.g., SIEF cost relief has been applied correctly, workers paid correctly).

Maintaining accurate records and tracking of all claims management activities and decisions and identifying claims that require further review.

Qualifications

• University degree in a relevant field (e.g.
  health, legal, business, risk management).
• 3 years of related/transferable work experience in the area of claims management, the legal field, or insurance industry.
• Experience in conducting research on relevant decisions and case law, interpreting legislation/policy, and reviewing/collecting/pulling relevant information from detailed/lengthy documents, claim records, or files.
• Experience in organizing and maintaining case records/files.
• Experience in preparing written submissions, appeals, or legal briefs.
• Coaching/training and providing technical guidance to others on a particular subject matter.
• Technical expertise in claims management, including experience reviewing claim files, understanding/researching medical conditions or injuries, applying disability duration guidelines and understanding recovery timelines, and using law/policy to make your case and substantiate your position with evidence.
• WSIB appeals experience is an asset.
• Familiarity with relevant WSIB law and WSIB Operational Policy Manual (OPM) that the WSIB uses to make decisions about worker and employer rights and obligations, employer premiums, benefits and other workplace safety and insurance matters, as well as the WSIB and WSIAT appeal processes, procedures and timelines.
• Exceptional communication skills to clearly convey succinct and convincing arguments in both written and oral formats.
• Excellent organizational skills and attention to detail.
• Excellent critical thinking skills to recognize assumptions, evaluate arguments, draw conclusions and prepare evidence-based written materials.
• Strong proficiency with computers and computer applications including, but not limited to, intermediate MS Office skills including Excel.
• Flexibility with the ability to handle multiple shifting priorities and deadlines within a constantly changing environment.
• Strong analytical and evaluative skills (e.g., to interpret financials).
• Strong investigative, research, and scientific thinking skills, with the ability to synthesize relevant information.
• Expertise in preparing written reports, briefing notes, or legal submissions.
• High degree of professionalism with strong ethics, and ability to demonstrate discretion and confidentiality.
• Proven ability to attend work regularly.
• Satisfactory criminal reference check and vulnerable sector search required.

Physical Requirements

The applicant must be able to meet the physical demands of this position.