Claims Management Analyst - Employee Health Services

Job Summary

The City of Mississauga is seeking a dynamic, knowledgeable and proactive Claims Management Analyst to join an amazing and supportive in-house Employee Health Services team.

Reporting directly to the Manager, Employee Health Services, the Claims Management Analyst will be responsible for the administration, monitoring and compliance of sick leave benefits as per program policy; WSIB claims administration, reporting and monthly billing; analysis, tracking, and trend reporting for all disability benefits, accommodations and wellness programming; and general Employee Health Services program administration and support, including Web Publisher for related program areas.

Duties and Responsibilities

•    Take appropriate action and work with stakeholders as required to ensure compliance to Time & Labour coding for employees on medical leave to prevent overpayments or address overpayments when they occur.
•    Review all workplace incident/accident activity reported on incident form related to medical aid and lost time incidents, to ensure completion and accuracy. 
•    Enter and log claims in the City’s claims management system
•    Create and review Form 7 WSIB reports in a timely manner to avoid fines.
•    Monitor WSIB claim correspondence (City Wide) for claim decisions and status updates and ensure all stakeholders are informed.
•    Process WSIB audit requests and provide information as required. 
•    Work with internal team, insurers and the WSIB to problem solve issues and ensure access to appropriate disability benefits (sick benefits and WSIB).
•    Reconcile weekly and monthly WSIB and LTD invoices; ensure timely payment to avoid interest charges; coordinate action with client groups and if required, escalate issues to other stakeholders.
•    Monthly auditing and reporting of LTD benefits 
•    Complete/submit relevant OMERS forms for eligible employees on sick leave benefit. 
•    Coordinate and manage reports used for interdisciplinary team meetings to discuss complex claims and return to work issues. 
•    Create, maintain, and support trending reports to evaluate: disability benefit utilization trends; accommodations trends and costing; impact of wellness and mental health initiatives.
•    Identify inefficiencies and process improvement opportunities, assist with development of and updates to standard operating protocols.
•    Coordinate and conduct logistical support for wellness initiatives.
•    Act as Web Publisher for Health & Wellness intranet site. 
•    Perform other duties as assigned.

Skills and Qualifications

•    Post-secondary education (diploma or degree) in business, human resources and/or occupational health related field.
•    A minimum of 3 years’ progressive experience with data analysis, metrics, and supporting business plans, preferably related to employee and workplace health or disability management
•    Experience using Disability Claims Management and HR Systems/Software is preferred
•    Exceptional analytical skills, including the ability to synthesize complex volumes of data into written reports, graphs and models
•    Strong interpersonal and communication skills 
•    Excellent organizational and problem-solving abilities with proven ability to multi-task
•    Ability to function in a team environment 
•    Excellent computer skills, with above average abilities in a variety of MS Office software
•    Excellent time management skills