Medical Review Consultant
About The Position
As the Medical Review Consultant, you will provide recommendations and interpretation to the Claims Team in order to support client decisions regarding rehabilitation plan of actions, disability management and benefit determinations considering medical documentation, regulations, and applicable case law. You will support the team and our accident benefits portfolio in competitive excellence, people, and client experience. You are responsible for monitoring claims ensuring all have appropriate rehabilitation management plans that are being implemented in a proactive and effective manner. You will work with the claims team to provide insight, guidance, and oversight for the management of rehabilitation of our clients and identifies and/or creates resources and training opportunities for the claims team.
Requirements
- 3 to 5 years of relevant clinical experience or related field.
- A post-secondary education in Medical, Insurance or related discipline.
- A Kinesiology, Physiotherapy, Occupational Therapy, Psychology, Nursing, or related medical discipline.
- A medical background as well as excellent working knowledge of injury and treatment protocols.
- The ability to critically analyze medical information and other claim documentation.
- Expert ability to interpret and apply complex regulations from various legislative schemes – high level of knowledge about new and existing case law and the ability to apply findings to similar situations.
Nice To Haves
- An innovative mindset to improve operational efficiencies and ability to influence change, with a primary focus on client needs.
- Critical thinking skills to recognize assumptions, evaluate arguments, draw conclusions and proactively propose solutions.
- Strong communication skills to clearly convey messages and explore diverse points of view.
- Ability to build trusting relationships and provide guidance to support the development of colleagues.
Responsibilities
- Analyzing medical and other file information, document conflicting or corroborating evidence to support the rehabilitation and disability management of our clients, including appropriate treatment and return to work plans.
- Providing medical and rehabilitation recommendations to support client recovery throughout the life of a disability claim. Analyzing our claims decision and identifying risks to our trust and reputation, and address immediately with the team.
- Identifying additional medical or other claims related information required for the exposure to ensure appropriate recovery plans for our clients. Identifying potential risks and errors and recommend strategies to mitigate.
- Working closely collaboration with the claims team to monitor the client experience through ongoing meetings to review progress, create and adjust treatment plans, and liaise with referral sources. Medical research/expert knowledge of complex injuries, treatment protocols, causation, and outcomes.
- Preparing reports which outlines findings, strengths, opportunities, and recommendations. Manage and document feedback, identify and analyze trends, interpret data, and provide reports.
- Researching and applying extensive medical knowledge of relevant jurisdictional, legislation, tribunal and case law that comes from all levels of court in Canada. Interpret and apply complex regulations, multiple legislations apply over the range of claim dates.
- Serving as a mentor and resource to the claims team, offering guidance on complex cases, system use, and procedural best practices. Providing coaching, peer review, and informal training to enhance the skill development of the team.
Benefits
- Training and development opportunities to grow your career.
- Flexible work options and paid time off to support your personal and family needs.
- A holistic approach to your well-being, with physical and mental health programs and a supportive workplace culture.
- Paid volunteer days to give back to your community.
- Competitive salary and incentive programs.
- Comprehensive total rewards package including group retirement savings plans, pension and benefits (e.g., health and wellness, dental, disability and life coverage), mental health support and an employee assistance program.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
