Claims Case Manager

POSITION: Claims Case Manager

LOCATION: La Capitale Civil Service Insurer - Mississauga

DEPARTMENT: Group Claims

REPORTS TO: Manager, Group Claims

Status: Permanent

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 us to make any accommodations, please advise us so that we can work with you to make suitable accommodations 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.


This role is primarily responsible for working directly with clients and working with many internal resources and departments to coordinate our services and improve customer satisfaction. The Group administrator service specialist could work with Account Executives, Employers, Client Service Representatives and/or other many internal resources, as well as directly with our client.

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 including methodology and timing to resolve issues
  • Review group contract provisions and submit medical information in order to identify discrepancies and inconsistencies when assessing disability benefit eligibility
  • Communicate and consult with internal/external providers, customers, Third Party Administrators, employers and Plan Administrators
  • Obtain medical and functional information through interviews, standard and customized questionnaires and written correspondence directed at claimants, policyholders and physicians
  • Review Short Term Disability case management plan and provide verbal and written recommendations to STD Adjudicator for review prior to case transferring
  • Execute problem resolution: identify, investigate, resolve or develop recommendations to address and resolve issues identified by internal and external parties
  • Review issues in light of applicable contractual, legal, medical, procedural system and client 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 and techniques
  • 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 an asset


  • 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)