Eligibility Adjudicator
Workplace Safety and Insurance Board
At the WSIB, you’ll have the opportunity to:
• explore many career paths and follow your passion
• continuously learn and grow professionally
• be recognized for the great work you do
• participate in programs that support your health and wellbeing
You’ll also receive a competitive salary, along with a comprehensive benefit package and defined benefit pension plan.
The WSIB is recruiting for current and future unilingual and bilingual (French speaking) opportunities in the following locations:
Guelph, Hamilton, Kingston, Kitchener, London, North Bay, Ottawa, Windsor, Sault Ste. Marie, Sudbury, Thunder Bay, Toronto, Timmins & Windsor
There may be a requirement to work 9:15am to 5:15pm
Salary Grade: 211 From: $73,559.14
Job Summary:
Use a proactive case management approach to make and communicate eligibility decision on benefits and services in a timely fashion that are consistent with relevant WSIB policy. Address worker and employer needs by actively listening, collecting and proving relevant information, and helping the workplace parties understand their rights, responsibilities and obligations.
Manage cases that are allowed, denied, reconsidered or resolved within established program guidelines, following a structured case management framework to enable them to achieve high quality eligibility decisions and successful outcomes.
Major Responsibilities:
1. Inform parties of their rights, responsibilities and obligations under the WSI Act and applicable legislation, and the consequences of non-compliance.
2. Proactively collect information from workplace parties and healthcare providers required for eligibility decisions and respond to inquiries.
3. Assess case and plan towards best outcomes. Make eligibility decisions quickly and accurately and communicate them, verbally and in writing by determining the following:
• The employer is covered under the Act;
• The worker is employed by the employer at the time of the injury;
• The injury is work-related;
• Proof of accident can be established;
• The diagnosis is compatible with the accident;
• Continuity and compatibility support ongoing entitlement in the case of recurrence;
• Ensuring accident reporting compliance with the employer.
4. Support workplace parties in their return to work (RTW) efforts by sharing any available information about the workers’ capabilities and/or precautions.
5. With the assistance of Payment Specialists where required, ensure appropriate earnings information is on file in order to determine the appropriate duration and level of benefits.
6. Review and monitor cases until closure or transition to a Case Manager, assessing RTW and recovery factors to differentiate cases requiring Case Manager expertise.
7. Refer requests to appropriate internal WSIB parties (Nurse Consultant, Account Specialist, Legal Services) to gain their expertise on various components of a claim when the need for appropriate intervention is recognized and follow up with them as required.
8. Attempt to prevent or resolve disputes, handle requests for reconsideration and, if unresolved, arrange access and process the objection.
9. Perform other related duties as assigned or required such as participation in the development and implementation of business plans and projects.
Job Requirements:
Education
• University completion at undergraduate level.
Experience
• Two years prior experience in adjudication and customer service.
• As a precondition of employment, the WSIB will require a prospective candidate to undergo a criminal records name check prior to or at any time following hire.
To apply for this position, please submit your application by the closing date noted above on the WSIB career site: https://www.wsib.ca/en/careers
We appreciate the interest of all candidates. Due to the volumes of applications we receive, we are only able to contact candidates that are selected to move forward in the recruitment process. The WSIB is an equal opportunity employer.
The WSIB is an equal opportunity employer and provides accommodation for job applicants in accordance with the Human Rights Code and the Accessibility for Ontarians with Disabilities Act. If you are an individual with a disability and you need accommodation in order to apply for this position, please contact [email protected]. If you are invited to participate in the assessment process, please provide your accommodation needs at that time. Please be advised that you may be required to provide medical documentation to the WSIB’s Corporate Health Department so that appropriate accommodation can be provided to you throughout the recruitment process.
Employees of the WSIB have important ethical responsibilities, including the obligation to place the public interest above personal interests. Job applicants are therefore required to disclose any circumstance that could result in a real, potential or perceived conflict of interest. These may include: political activity, directorship or other outside employment and certain personal relationships (e.g. with existing WSIB employees, clients and/or stakeholders). Please contact TAC if you have any questions about conflict of interest obligations and/ or how to make a disclosure.
Privacy Statement
Personal information will be collected from your resume, application, cover letter and references under the authority of the Workplace Safety and Insurance Act, 1997 and will be used by the Talent Acquisition Centre and WSIB hiring parties to assess/validate your qualifications and/or determine if you meet the requirements of vacant positions and/or gather information relevant for recruitment purposes. If you have questions or concerns regarding the collection and use of your personal information, contact the WSIB Privacy Office, 200 Front Street West, Toronto, ON, M5V 3J1 or 416-344-5323 or 1-800-387-0750 extension 5323. Be advised that information related to application status will not be provided.