Pacific Blue Cross has been British Columbia's leading benefits provider for 80 years. We are an independent, not-for-profit society with strong roots in BC’s health care system. Together with our subsidiary BC Life, we provide health, dental, life, disability and travel coverage to 1 in 3 British Columbians through employee group plans and individual plans.
We are fueled by a commitment to keep health care sustainable for all British Columbians. Through our Pacific Blue Cross Health Foundation, we also provide funding to community organizations with a focus on alleviating mental illness and chronic disease. We're interested in finding people who want to make a difference and who will take advantage of every opportunity to build a career with us.
Pacific Blue Cross offers an attractive compensation and benefits package, fitness programs, and an onsite gym and cafeteria. Our workplace culture values health and wellness, continuing education, environmental sustainability and giving back to the community.
If you are committed to improving the health and well-being of British Columbians, we are currently recruiting for an up to 12 month Disability Claims Administrator to join our Work & Wellness team. The role is temporarily working from home but will be located at our head office in Burnaby, BC, with the option to work from home during the COVID-19 pandemic.
Under general supervision of the Assistant Manage, staffs an assigned phone queue to receive, screen, respond to and redirect incoming calls from claimants and external contacts. Provides a variety of administrative support services to claimants, groups, agencies and contacts to facilitate the distribution of claims-related information and documentation, and to expedite appointments and referrals. Provides a variety of administrative services related to the receipt and processing of BC Life claims including preliminary eligibility verification for short term disability. Researches and verifies policy information for life conversions and generates premium calculations. Follows up on long term maintenance claims to determine if claim payments are to be extended. Researches and follows up on Not In System mail. Supports a team of medical consultants through the compilation of file documentation, arranging meetings and downloading medical transcriptions from external service provider. Supports the BC Life team by compiling and producing reports using word processing and spreadsheet applications, and providing general administrative and clerical services including payment of legal invoices at manager request.
Customer, Client and Member Services
- Staffs an assigned phone queue to receive, screen, respond to and redirect incoming calls from claimants and other external contacts. Escalates calls to senior staff members where required. Applies a variety of customer service tools and techniques to clarify client issues, diffuse hostility, ensure open communication and promote customer well-being.
- Provides a variety of administrative support services to claimants and other external individuals, groups, agencies and contacts including:
a. verifying claimant cheques for financial institutions;
b. verifying and activating electronic funds transfer data for claimants;
c. distributing a variety of forms relating to type of coverage including CPP and LTD applications;
d. expediting claimant appointments for case management interventions such as independent medical examinations initiated by adjudicators including obtaining information about appointment costs, availability and length of time required for appointments; makes related travel arrangements through a third party travel service provider; distributes claimant letters with appointment details;
e. coordinating referrals to contracted external rehabilitation consultants and other third party service providers including compilation of related referral documentation;
f. requesting duplicate T4A and T5s from Finance;
g. generating and distributing group-specific payments.
- Generates graduated return to work payments for disability claims by entering offsets, issuing payments, identifying variances between employer and adjudicator payment information and following up to ensure missing information is obtained and on time claims payments are made.
- Generates reports for short term claims, issues payments and schedules new short term claim tasks in ACES.
- Provides administrative services for life waiver claims by logging claimant data including basic information, effective dates of coverage and status of claims. Follows up with third party administrator to verify and correct claimant data.
BC Life Claims Processing
- Provides a variety of administrative services related to the receipt and processing of BC Life claims by:
a. monitoring general and group-specific email inboxes, screening, printing and distributing emails to appropriate area including Claims Clerks for logging and adjudicators where further action is required;
b. responding to email requests from adjudicators to distribute standard documentation to claimants or other contacts;
c. identifying variances in client ROC (Repository of Client) data and forwarding to Group Services for correction;
d. reviewing automatic payment errors and notifying adjudicators of failed autopayment;
e. issuing stop payments and requests re-issues on cheques as directed by adjudicators and for cheques issued to claims not registered in ACES.
- Researches and verifies policy information for life conversion inquiries, confirms living benefits previously paid and generates life conversion premium calculations through an established spreadsheet. Prepares quotation letters via Word template, distributes applications and compiles completed application information. Forwards to individual life carrier and acts as liaison between finance, claimant and individual life carrier.
- Reviews incoming short term disability claims to determine preliminary eligibility status of claimants by verifying accuracy and completeness of claimant and policy data on employer, employee and attending physician statements depending on claim type. Calculates tax payable using established federal tax tables. Initiates contact with individual claimants, plan administrators and employer contacts to clarify claim information such as salary hours, occupation or last day worked, and to request missing statements. Sets up and monitors task lists to ensure information is received within established turnaround times. Escalates adjudication situations to Disability Adjudications Specialists, and situations requiring indepth research or correction of system related information to Team Leader or other internal PBC departments for action.
- Follows up on long term maintenance claims to determine if claim payments are to be extended in accordance with established criteria. Distributes reinsurer and maximum benefits notifications.
- Merges short term with long term disability files when STD maximums have been reached.
- Receives and researches Not In System (NIS) mail to determine status. Follows up with claimants or other external contacts to collect missing information and matches mail to open or closed claims. Redirects misdirected mail and researches addresses for returned mail. Provides back up relief for Disability Claims Clerks on filing and regular mail receipt, sorting, stamping, mail entry and mail delivery.
Internal Customer Service
- Supports a team of medical consultants by compiling documentation including time tracking log sheet, transcription templates (“dragons”) and external physician contact letters. Prepares files. Arranges meetings with medical consultants and internal staff members. Arranges for transcription downloads through a third party transcription service and advises adjudicators of completed medical consultant tasks. Provides other clerical support on request including photocopying. Processes log in and time tracking data for payment purposes.
General Team and Department Support
- Using the intermediate features of Excel including sorting, filtering, creation and merging of tabs, page setup features such as page breaks and alignment, prepares, updates and produces a variety of operational, statistical and group-specific reports such as monthly and quarterly Board reports, graduated return to work payments, semimonthly payment reports, and medical consultant reviews and log in sheets.
- Using the intermediate features of Word including character, paragraph and page formatting, prepares a variety of documents such as draft work procedures and non-templated correspondence.
- Plans the content of and composes a variety of written documents including freeform email responses to external contacts which adhere to the established standards of business English and internal style guidelines.
- Performs the TMSS Schedule role for BC Life by:
a. ensuring employees clock in and out as required;
b. keying all missed or exception entries and adjustments including daily leave request; administers vacation changes and Family Responsibility Leave balances;
c. opening and processing weekly leave requests and updating department attendance reports;
d. approving timesheets for payroll within established procedures;
e. responding to all inquiries, demonstrating use of the system on a one-to-one basis to new users, and maintaining liaison with Human Resources as required to resolve more complex issues and adjustments.
- Performs a variety of administrative activities to support BC Life leadership team and staff including:
a. booking and posting meeting room notices in Outlook, and posting meeting room calendars;
b. transcribing voice mail messages for claims adjudicators;
c. providing information to actuarial team on optional employee, spousal and child benefits used in the calculation of reserves, and on life conversions for volume of conversions received;
d. generating payment for legal costs approved by managers;
e. archiving email inboxes annually.
- Performs end of day lock up procedures to ensure sensitive claimant information is secure in accordance with privacy legislation requirements.
- Provides input to the creation and content of new and revised work procedures and provides feedback on related training materials.
- May participate in a variety of special projects and clean up tasks related to claims administration.
- On a one to one basis, supports new employees by demonstrating the execution of specific tasks and duties, and sharing knowledge and experience on request.
- Performs other assigned duties related to administration or clerical support which do not affect the rating of the job.
- High school graduation or equivalent.
- A minimum of one year previous related experience in a customer service-oriented position such as inbound call centre agent or dealing with customer inquiries over the phone (or equivalent).
- Completion of a Business Communication course (36 hours) or equivalent.
- Demonstrated proficiency in the use of Intermediate Word and Excel, and Basic Math.
- Completion of Intermediate Word course (18 hours)
- Completion of Intermediate Excel course (18 hours)
- Minimum typing skills of 40 wpm
While we thank all candidates for their interest, only shortlisted candidates will be contacted.
Job Types: Full-time, Temporary, Contract