Senior Disability Claims Specialist

La Capitale Civil Service Insurer Inc. 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 Inc. 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.

SUMMARY OF RESPONSIBILITIES:

The incumbent will act as the principal litigation analyst and will be involved in the management of litigation for Group Disability and Health Care benefits. The incumbent will also play a significant role in determining lump sum settlements.

MAIN ACCOUNTABILITIES:

• In collaboration with lawyers, determine which strategy should be followed and implemented for claims cases with formal notice to lawyers and clients.
• In collaboration with lawyers, negotiate necessary agreements with clients.
• In collaboration with lawyers, plan all activities (steps to follow, procedures, delegation of responsibilities, etc.) related to litigation with the legal department.
• In collaboration with lawyers, determine the strategies (mediation, litigation, etc.) to adopt in legal files.
• Analyze the disability cases that are at risk of litigation or in litigation, to identify elements of risk for the company.
• Collaborate to develop a clear and comprehensive summary of each of the contentious cases that provides an opinion and recommendations, including accompanying steps to follow for the medical and administrative aspects.
• Establish contacts with various stakeholders and experts to develop strategies and prepare required reports, evidence and documentation.
• Maintain an updated report on litigated cases (quarterly financial statements).
• Maintain daily tracking for each litigated case and send it to the Senior Director.
• In collaboration with lawyers, make recommendations to the Senior Director concerning the process and direction of litigation.
• Responsible for ensuring confidentiality of personal information under PIPEDA and the applicable provincial privacy legislation.
• In collaboration with the Leadership Team, ensures maintenance of level of knowledge of contentious issues among all employees.
• Coordinate vendors for investigation/surveillance activities of disability cases and discuss strategies for files with current investigation.
• Holds decision-making authority on the amounts of lump sum settlements to the level that is granted.
• Performs any other related duties as assigned.

EXPERIENCE/EDUCATION:

• Bachelor’s degree in a relevant discipline with a minimum of five (5) years of experience in managing disability benefits;
• Excellent knowledge of administrative procedures in group insurance, contractual clauses and disability insurance settlement clauses;
• Analytical skills and critical thinking;
• Proven ability to impact and influence;
• Very good knowledge of the legal environment of group insurance;
• Excellent command of English and French would be an asset;
• Knowledge of provincial legislation regarding the field of life and health insurance

Please submit resume and cover letter to jobs@lacapitale.com (Opens in an email tools)