Through consultation with case management personnel in the Disability Management Services Offices, the Claims Investigation Specialist will work to develop and maintain a comprehensive, enhanced and expanded focus on the investigation and management of suspicious claims. The goal is to improve claims morbidity and improve active case management by:
- Identifying and declining fraudulent claims, prior to any liability being accepted
- Identifying and terminating active fraudulent claims, reducing claims durations and releasing Disability Life Reserves (DLR’s)
- Increasing the volume of claims that are successful in achieving restitution / restitution orders via the criminal and civil process
Due to the nature of the role, this position can be located at any of the following cities; Vancouver, Langley, Calgary, Edmonton, Regina, Winnipeg, Toronto, Scarborough, London, Hamilton, Ottawa, Halifax, St. John's, Montreal.
- Consult with the Disability Management Services offices on the investigation and management of specific suspicious claims and provide direction and support to ensure an efficient and effective investigation is completed
- Provide recommendations on communication with plan member, plan sponsor, physician, other parties
- Assist with the interpretation and analysis of investigation findings
- Liaise with the Special Investigation Unit and Legal Department when fraudulent claims are identified
- Conduct investigation on Short Term and Long-Term Disability claims, as necessary, when the field investigation has been completed and the claim has been referred to Head Office
- Provide a clearly articulated claim summary for use by the Specialist Investigations Unit and Legal Department
- Create and maintain reference and training material for the field.
- Develop and maintain reporting to enhance our ability to track the success of our fraud management program.
- Manage and conduct the social media searches/process with a disability lens in mind (understanding the underlying disability claims specifics is critical)
Qualifications and Competencies:
- Holds a bachelor's degree or college diploma in an appropriate discipline and/or the equivalent relevant professional experience
- A minimum of 5 years’ experience in a disability case management role
- Solid knowledge and understanding of a variety of medical conditions, their expected functional impacts and their standard treatment protocols
- Extensive knowledge of disability insurance
- Strong decision-making, problem solving skills and analytical skills
- Excellent organizational and time management skills; able to handle multiple, simultaneous investigations
- Exceptional communication skills, both written and oral, including:
- An ability to negotiate with people in a variety of roles, internally and externally
- An ability to coach case managers in a positive manner
- Proven experience providing excellent customer service
- Strong report \ documentation skills
- Able to work independently and within a team environment
- Demonstrated proficiency using Excel and Word
- Successful candidates will be required to participate in the Federal Government Enhanced Screening Process
Discover your opportunity….Apply today!
Great-West Life offers competitive compensation, great benefits such as medical, dental, life insurance, wellness account and personal days not to mention onsite cafeteria and fitness facilities. If you’d like to join our team submit your information online and introduce yourself.
Together Great-West Life, London Life and Canada Life serve the financial security needs of more than 13 million people across Canada, with additional operations in Europe and the United States. As members of the Power Financial Corporation group of companies, we’re one of Canada’s leading insurers with interests in life insurance, health insurance, investment and retirement savings. We offer a broad portfolio of financial and benefit plan solutions for individuals, families, businesses and organizations.
We are committed to providing an inclusive, accessible environment, where all employees and customers feel valued, respected and supported. We are dedicated to building a workforce that reflects the diversity of the communities in which we live, and to creating an environment where every employee has the opportunity to reach their potential.
Great-West Lifeco would like to thank all applicants, however only those who qualify for an interview will be contacted.*LI-JB2