Claims Management and Return to Work Specialist
About The Position
24/7 OEMS is seeking to fill a Claims Management and Return to Work Specialist role. This position is full-time, working remotely from home. The Claims Manager and RTW Specialist (CM) will be responsible for providing comprehensive disability case management services to multiple clients primarily in the mining industry. The CM will work collaboratively with employees, employers, medical professionals, insurers, and workers’ compensation boards to identify barriers, determine fitness for work, and facilitate safe, timely, and sustainable return to work plans. The CM will support the development and integration of disability management policies, procedures, and documentation aligned with industry best practice and privacy legislation.
Requirements
- Completion of a Nursing, Occupational Health, Physician Assistant, or related healthcare program and/or relevant experience in disability management within an occupational health environment.
- Minimum 5 years of experience in disability claims management, adjudication, or a combination of equivalent experience and specialized education.
- Strong knowledge of group benefits, disability products, and experience working with insurance carriers, Third-Party Administrators and Workers’ Compensation Boards.
- Proficiency with Microsoft Office (Word, Excel, Outlook) and the ability to work with electronic medical record systems (e.g., Cority).
Nice To Haves
- College or university degree, certificate, or continuing education toward Occupational Health Nursing (OHN) or similar designation.
- Experience working with unionized workforces.
- Demonstrated participation in ongoing professional growth and development activities.
- Ability to manage complex and sensitive cases with professionalism and integrity.
- Strong interpersonal, communication, and customer service skills.
Responsibilities
- Coordinate and manage disability cases for both occupational and non-occupational claims.
- Develop, implement, and monitor individualized return-to-work and modified work plans.
- Determine fitness to work and claim eligibility in consultation with Deputy Medical Directors and onsite medical personnel, where applicable.
- Review medical documentation, claim forms, investigation reports, and functional abilities information to support decision-making.
- Coordinate referrals for medical clarification, functional abilities assessments, and independent medical examinations as required.
- Act as the primary liaison between employees, employers, human resources, management, medical providers, insurers, and workers’ compensation boards.
- Clearly explain the disability case management process, including roles and responsibilities of all stakeholders.
- Provide concise, professional written and verbal communication within applicable privacy legislation.
- Collaborate with HR and business representatives to review claim status and RTW timelines.
- Receive, process, and maintain medical absence and RTW documentation in compliance with privacy legislation.
- Maintain accurate and confidential medical records using electronic medical record systems.
- Support other projects such as wellness initiatives and health promotion as required.
- Some flexibility in work hours may be needed to accommodate time zones and occasional travel to site may be required.
Benefits
- Employer sponsored benefits
- Long-term disability paid by employee
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
1,001-5,000 employees
