Bilingual Disability Claim Specialist (Complex Claims & COD)

THE EMPIRE LIFE INS. CO • Montreal, QC

2d • CA$78,698 - CA$125,350 • Remote

About The Position

Empire Life is looking to hire a Disability Claim Specialist (Complex Claims & COD) to join our Group Operations team! We are actively seeking candidates to fill a current, open position. The Disability Claim Specialist is a senior subject matter expert responsible for the proactive and strategic management of complex long-term disability (LTD) claims, with a strong focus on cases approaching or undergoing a Change of Definition (COD) from "own occupation" to "any occupation." As a key member of the active claims team, this individual provides expert consultation, mentorship, and direct case management to ensure claim decisions are sound, fair, and aligned with policy provisions and organizational best practices. This role is critical in mitigating financial and legal risk, driving service excellence, and enhancing the overall capabilities of the disability claims team.

Requirements

• Bilingualism in French and English is required
• 5-10 years of experience managing LTD claims
• Undergraduate degree in kinesiology, anatomy, biology, life sciences, rehabilitation, psychology, or related.
• Claims Management Expertise: Deep knowledge of disability claims, including the ability to manage complex cases, understand policy language, and navigate legal or medical complexities. Experience with appeals and escalations is critical.
• Analytical and Problem-Solving Skills: The ability to analyze data and trends to identify root causes of issues, evaluate complex claims, and make sound recommendations. This includes proficiency in identifying process improvements and knowledge gaps.
• Leadership and Mentorship: Experience in coaching, mentoring, and providing constructive feedback to peers. The role requires the ability to serve as a subject matter expert, conduct sign-offs, and guide professional development.
• Communication Skills: Strong written and verbal communication is essential for leading discussions, providing clear recommendations to managers, and coaching team members.
• Organizational Skills: The capacity to manage a caseload, proactively review claims at specific intervals, and support the day-to-day activities of a team.
• If you are applying for a position which is open to applicants across Canada, unless otherwise indicated in the position, language proficiency in English is required for communicating with customers, advisors, or employees across Canada.

Nice To Haves

• LOMA 280, 290, HIAA, CEBS - GBA are assets

Responsibilities

• Proactively manage/support a dedicated portfolio of high-complexity LTD claims, including those with significant medical, vocational, or contractual challenges.
• Support the Change of Definition process by coaching and signing off on Change of Definition milestones, determining a claimant's capacity to engage in "any occupation" based on their education, training, and experience.
• Develop and execute comprehensive case management strategies, utilizing medical, vocational, and other expert resources/vendors to ensure objective and well-supported claim decisions.
• Drive a culture of early intervention to provide best claim outcomes.
• Expertly manage and adjudicate claim appeals, conducting thorough and impartial reviews of new evidence, including sound documentation and communication of the decision.
• Serve as the primary resource and subject matter expert for Disability Case Managers on all matters related to Change of Definition and complex claim files.
• Provide coaching, technical guidance, and mentorship to team members to build their skills in assessing transitional skills, labour market analyses, and vocational rehabilitation potential.
• Lead team sessions to review complex files, offering strategic direction and fostering a collaborative, knowledge-sharing environment.
• Conduct quality assurance reviews on COD files and complex claims to ensure consistency, accuracy, and adherence to best practices.
• Analyze claim data to identify trends, patterns, and risk factors associated with COD claims.
• Develop and maintain reports on COD outcomes, including return-to-work successes, claim resolutions, and appeals, providing insights to leadership.
• Leverage data to recommend process improvements and inform departmental strategies for managing LTD Claims.
• Communicate complex claim decisions and rationale with empathy, clarity, and professionalism to claimants, employers, and other partners.
• Effectively manage sensitive and potentially contentious claim situations, utilizing advanced negotiation and conflict resolution skills.
• Collaborate with internal and external partners, including legal counsel, medical consultants, and vocational rehabilitation specialists, to achieve optimal claim outcomes.

Benefits

• Competitive salaries with annual pay increases
• Annual bonus program, which recognizes both strong company performance and individual contributions, for non sales positions
• A comprehensive employer-funded benefits package starting from day one of employment, that includes life insurance, disability, health and dental and a generous health account
• Flexible work arrangements and an annual allotment of personal health days.
• Four weeks annual vacation from hire date
• A defined contribution pension plan with generous employer matching
• Top up programs for parental leave and compassionate leave
• Employer-sponsored wellness and recognition programs
• A cash employee referral program

What This Job Offers

• Job Type: Full-time
• Career Level: Senior