Claims Case Manager

POSITION: Claims Case Manager

LOCATION: La Capitale Civil Service Insurer - Mississauga

DEPARTMENT: Group Claims

REPORTS TO: Manager, Group Claims

Status: Permanent


A Great Place to Work!

Come work for one of Canada’s Best Employers for 2018! We take great pride in the corporate culture our employees have created at La Capitale. We also have excellent benefits and recognition programs, a “green” building and ample learning and development opportunities for our staff. Take a look at the newest opportunity to join our team.

The Role:

We are looking for a self-motivated Disability Case Manager to provide excellent service while adjudicating Short and Long-Term Disability Claims. You will develop case management plans, analyze medical, contractual and eligibility information and communicate with internal and external stakeholders.

Your Profile:

You have a University degree, preferably in a related field, and at least 2 years of Disability Case Management experience. You have excellent communication, multitasking and organizational skills. If you are bilingual (French/English) and are working towards an industry designation (ALHC, FLMI, GBA), that would be a bonus!

Please see our full job posting below:

La Capitale Civil Service Insurer is committed to providing a diverse, inclusive work environment free of all forms of discrimination, including discrimination on the basis of physical or mental disability, or medical condition. If you are interested in pursuing a job opportunity with La Capitale Civil Service Insurer and require accommodation, please advise us so that we can work with you to provide suitable accommodation in the recruitment and selection process.


Adjudicate and manage short term and (primarily) long term disability claims. Provide efficient and timely service to all key stakeholders.

Main Accountabilities:

  • Provide long-term disability claim assessment
  • Identify, obtain and analyze key medical, contractual and eligibility information
  • Develop case management plans that identify direction, issues and action plan includingmethodology and timing to resolve issues
  • Review group contract provisions and submit medical information in order to identifydiscrepancies and inconsistencies when assessing disability benefit eligibility
  • Communicate and consult with internal/external providers, customers, Third PartyAdministrators, employers and Plan Administrators
  • Obtain medical and functional information through interviews, standard and customizedquestionnaires and written correspondence directed at claimants, policyholders andphysicians
  • Review Short Term Disability case management plan and provide verbal and writtenrecommendations to STD Adjudicator for review prior to case transferring
  • Execute problem resolution: identify, investigate, resolve or develop recommendations toaddress and resolve issues identified by internal and external parties
  • Review issues in light of applicable contractual, legal, medical, procedural system andclient specific requirements in order to achieve a resolution


  • University degree preferably in Health Sciences or related disability experience
  • Sound knowledge and ability to apply appropriate disability risk management tools andtechniques
  • Ability to plan, develop and implement goal-oriented claim management plans
  • Strong ability to interpret and apply group contract provisions
  • Sound knowledge of medical terminology, medical management and pharmacology is anasset


  • Excellent written and verbal communication skills
  • Bilingualism in French/English is an asset
  • Excellent customer service
  • Intermediate skills with Word and Excel
  • Ability to multitask in a fast paced, performance driven environment
  • Strong planning and organizing skills, with strong attention to detail
  • Analytical thinker with proven problem solving skills
  • Ability to adapt quickly and comfortably to change
  • Good interpersonal skills
  • Professional telephone etiquette
  • Demonstrates a positive attitude and a desire to succeed
  • Strong team player
  • Prefer one or more industry courses completed and working towards an industry designation (e.g. ALHC, FLMI, GBA)


If you feel you qualify for this opportunity and would like to apply, please attach your resume and forward your application to Human Resources via email to (Opens in an email tools)