Representative, Incident Reporting & Claims

Contenido de trabajo

Job Summary

Supporting the Vision, Values, Purpose and Commitments of Fraser Health:

On behalf of the Health Authorities of BC (FHA, VIHA, VCH, PHSA, PHC, BCCSS, NHA, IHA), the Representative, Employer Incident Reporting and Claims, provides effective WorkSafeBC (WSBC) claims management and administrative support for the WSBC Claims process on behalf of the customers of the Provincial Workplace Health Call Centre in compliance with WSBC regulations. Supports injury and/or exposure claims administration to employees, managers, and Human Resources staff at each of the Health Authorities by assessing customer needs and adhering to Workplace Health/Human Resources policies, procedures and relevant collective agreement provisions. Acts on behalf of the Health Authorities to evaluate, determine and decide which claims should be protested. Liaises with WorkSafeBC to reconcile claims issues and with local Health Authority representatives regarding their claims position on protested difficult cases. Acts as the Employer’s Representative when electronically filing appeal submissions to the Review Division or WCAT at WSBC. This centralized service centre processes high volumes of claims and appeals on behalf of the employer groups served under a Provincial Participation Agreement.

Duties & Responsibilities

• Implements WSBC claims processes to ensure the effective and efficient management of WSBC claims within the initial phase of the claim cycle for each Health Authority.
• Performs phone interviews to capture details of workplace incidents from employees and managers, collecting required information to initiate employee incident exposure report; reviews incident information to assess employer liability and apply protest on behalf of the employer(s) on the WorkSafeBC Form 7 Employer’s Report; and submit employers’ claims reports according to WSBC policy and regulations. Documents all interactions and call recordings with Employees and Managers in the Employee Health Record in the WHITE system.
• Accesses WorkSafeBC Employer Portal Accounts to review confidential WorkSafeBC claim status letters on behalf of the Health Authorities. Reviews and processes Employer Form 7 requests received from WorkSafeBC via individual Employer Portal Accounts for each Health Authority.
• Liaises with Health Authority representatives and WorkSafeBC during the initial stages of the claim to verify details such as claims status, reconcile duplicate claims filed, and update the employer’s position regarding WorkSafeBC requests to change protests made on claims.
• Receives and reviews decision letters from WSBC and determines whether the employer will proceed with appeals for relief of cost and/or claims acceptance by submitting appeal requests with justification for appeal to WSBC’s Reviews Division or WCAT.
• Acts as a contact for internal and external WSBC claims inquires; refers to appropriate team member when necessary.
• Regularly reviews WorkSafeBC regulations and policy for changes impacting department processes related to claims, appeals and protest criteria. Reviews and determines whether department policies and procedures are consistent with the Workers Compensation Act.
• Liaises with WorksafeBC to develop employer reporting processes for WorksafeBC Employer Claims reporting on behalf of all Health Authorities.
• Responsible for developing and maintaining a claims reference manual for the department to assist in determining when and how to apply various protests to claims that meet the outlined criteria for protesting.
• Works in conjunction with WorksafeBC and Employer Appeal representatives to ensure Call Centre Assistants are meeting employer’s requirements for appropriate protesting of the WorkSafeBC Employer’s Report (Form 7) on behalf of all Health Authorities.
• Represents the interests of the department at assigned meetings and committees with WorkSafeBC and Health Authority representatives.
• Compiles, analyses and maintains statistical data; produces and distributes summaries and reports as required.
• Responsible for performance Call Centre Metrics, Agent Statistics, Error Reports and Work Activity Tracking for managing personal work performance.
• Provides orientation to new hires as directed by the Leader, Incident Reporting & Claims.
• Provides support coverage for the Leader, Incident Reporting & Claims when away as required.
• Performs a variety of administrative duties using various software application programs and maintains efficient electronic filing systems to fulfill required needs.
  

Qualifications

Education, Training, and Experience

Grade 12 plus 1 year relevant post-secondary coursework such as Occupational Health & Safety, Disability Management, Claims Management, Human Resources or equivalent work-related experience. Contact Centre and Leadership training or experience is an asset.