Conseiller / Conseillère en indemnisation des accidents du travail – Niveau 2 / Workers Comp Consultant - Level 3

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.

OBJECTIF : Analyser les demandes d'indemnisation des accidents du travail des cadres moyens et supérieurs afin de déterminer les indemnités dues; veiller à ce que le traitement des demandes soit conforme aux normes de l'entreprise et aux meilleures pratiques du secteur; repérer les demandes de subrogation et négocier les règlements.

PRINCIPALES FONCTIONS ET RESPONSABILITÉS

• Traiter les réclamations d’indemnisation des travailleurs en déterminant la recevabilité et les indemnités dues pour les réclamations d’indemnité à long terme, surveiller l’exactitude des provisions et déposer la documentation requise auprès de l’organisme provincial.
• Élaborer et gérer les plans d’action des réclamations d’indemnisation des travailleurs jusqu’à leur règlement, coordonner les efforts de retour au travail et approuver les paiements des réclamations.
• Approuver et traiter les réclamations attribuées, déterminer les indemnités dues et gérer le plan d’action conformément à la réclamation ou au contrat du client.
• Gérer la subrogation des réclamations et négocier les règlements.
• Communiquer les mesures relatives à la réclamation avec le demandeur et le client.
• Veiller à ce que les dossiers de réclamation soient correctement documentés et que la codification des réclamations soit exacte.
• Peut traiter des réclamations médicales complexes à vie et/ou pour une période définie, incluant les dépôts auprès de la province et des médecins ainsi que les décisions concernant les traitements appropriés recommandés par l’examen de l’utilisation.
• Maintenir des relations professionnelles avec les clients.

AUTRES FONCTIONS ET RESPONSABILITÉS

• Accomplir d'autres tâches qui lui sont assignées.
• Soutenir le(s) programme(s) qualité de l'organisation.
• Voyager si nécessaire.

QUALIFICATIONS

Formations et permis

• Baccalauréat obtenu dans une université ou un établissement d'enseignement supérieur agréé, un atout.

Expérience

• Quatre (4) ans d’expérience en gestion des réclamations ou une combinaison équivalente de formation et d’expérience.

Compétences et connaissances

• Connaissance pratique des réglementations, des compensations et des déductions, de la durée de l'invalidité, des pratiques de gestion médicale et des procédures de demande de sécurité sociale et d'assurance maladie applicables au secteur d'activité concerné.
• Excellentes compétences en communication orale et écrite, y compris en présentation.
• Maîtrise des outils informatiques, notamment des produits Microsoft Office.
• Compétences analytiques et interprétatives.
• Solides compétences organisationnelles.
• Bonnes aptitudes interpersonnelles.
• Excellentes compétences en négociation.
• Capacité à travailler en équipe.

Capacité à respecter ou dépasser les attentes en matière de service.

• Paralegal expertise for handling claims, appeals, and compliance matters
• Strong knowledge of workers’ compensation legislation and health & safety standards
• Proven ability to manage complex claims processes and collaborate with stakeholders
• Experience in HR leave programs, disability case management, and policy interpretation

PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

• Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
• Negotiates settlement of claims within designated authority.
• Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
• Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
• Prepares necessary state fillings within statutory limits.
• Manages the litigation process; ensures timely and cost effective claims resolution.
• Coordinates vendor referrals for additional investigation and/or litigation management.
• Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients.
• Manages claim recoveries, including but not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets.
• Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner.
• Communicates claim activity and processing with the claimant and the client; maintains professional client relationships.
• Ensures claim files are properly documented and claims coding is correct.
• Refers cases as appropriate to supervisor and management.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

• Performs other duties as assigned.
• Supports the organization's quality program(s).
• Travels as required.

QUALIFICATIONS

Education & Licensing

• Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Experience

• Five (5) years of claims management experience or equivalent combination of education and experience required.

Skills & Knowledge

• Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business.
• Excellent oral and written communication, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Good interpersonal skills
• Excellent negotiation skills
• Ability to work in a team environment
• Ability to meet or exceed Service Expectations

Job type:

This posting is to create a candidate pool for future opportunities
 

Compensation Information:
Salary Range: $65,000 - $80,000 CAD annually

Compensation is determined based on experience, qualifications, and internal equity. Sedgwick is committed to transparent and equitable pay practices.

The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

Where applicable, Sedgwick uses artificial intelligence tools to assist in the screening, assessment, or selection of candidates. These tools are subject to periodic review.

We are committed to inclusive, barrier-free recruitment and selection processes. If contacted for an employment opportunity, please advise Colleague Resources if you require accommodation.

Sedgwick is an Equal Opportunity Employer