Organization: WCB Manitoba
Job Title: Adjudicator II
Job Type: Permanent, Full-time
Location: Winnipeg, Manitoba, Canada
The Adjudicator II is responsible for adjudicating and managing claims in the Short Term Claims department of up to 14 weeks duration, and Hearing Loss claims in the Occupational Disease Unit for the entire length of the claim.
Determines which claims are acceptable and authorizes/denies entitlement to compensation on an ongoing basis; where required, communicates the decision and rationale to injured workers, employers, representatives, and healthcare practitioners.
Gathers, assembles, reviews, develops, and assesses information and opinions through written correspondence, in-person meetings, and telephone to establish initial and ongoing entitlement to compensation.
Communicates with injured workers, employers, representatives, healthcare practitioners, witnesses, and other involved parties to obtain/provide information, respond to enquiries and explain decisions, in writing or verbally.
Gathers appropriate wage information and provides direction to Payment Assessors re: payment of a claim and duration.
Identifies claims where a pre-existing condition exists, establishes entitlement accordingly, and authorizes or denies cost relief to employers.
Manages and facilitates the overall claim process (ie. assessing, planning, implementing, coordinating, monitoring, evaluating and terminating) for claims involving up to 8 weeks of wage loss benefits.
Acts as a primary contact for workers, employers, representatives, healthcare practitioners, and specialized service providers to ensure the coordinated management of claims through the recovery process to return to work or other resolutions.
Identifies potential stress/crisis situations, facilitates established protocols for intervention.
Implements Chiropractic and Physiotherapy Protocol by identifying the appropriate category and coverage period and notifies all parties in writing. Monitors no time loss claims involving physiotherapy or chiropractic treatment for up to 14 weeks from date of injury. Manages noise induced hearing loss claims for the entire duration of the claim.
Determines spousal and dependent’s entitlement on fatality claims and refers files to appropriate internal resources for ongoing management.
Delivers presentations or attends information/discussion sessions on behalf of the WCB with external stakeholders. This may include providing an overview of Adjudication and Case Management processes.
Independently, or in consultation with internal/external service providers, provides service to injured workers by assessing and facilitating return to work on an individual basis. This includes development of a strategy to bring each claim to resolution.
Promotes and supports workplace-based disability management programs.
Initiates recovery of overpayments within guidelines.
Authorizes medical aid expenditures on files up to $25,000 and makes recommendations to the Supervisor/Manager/Director.
Identifies claims where cost allocation/relief is appropriate per legislation and policy.
Gathers/assembles information requested, implements decisions and reviews information received from senior staff, the Review Office, Medical Review Panel, Appeal Panel.
Ensures proper recording of claims involving inter-provincial and third party, as well as coding of all occupational disease claims.
Identifies and recommends improvements in service or system/policy changes related to adjudication and case management.
May assist in the training/orientation of new Adjudicators.
Performs other related duties as assigned.
Grade 12 and completion of a 2 year diploma in a related discipline.
Two (2) years' experience as an adjudicator or 2 years' experience in a similar environment making entitlement decisions based on a defined set of criteria (ie. policies, procedures, legislation, etc.) including client service experience.
Demonstrated proficiency in the use of personal computers and software in a Windows environment.
Knowledge of adjudicative, disability management, and workplace-based programs, policies, procedures and principles, would be an asset.
Demonstrated ability to obtain, assess and evaluate information to support claims decisions.
Knowledge of medical terminology/issues, would be an asset.
Demonstrated ability to interpret and apply provisions, policies, procedures and legislation.
Demonstrated ability to communicate effectively, both verbally and in writing.
Demonstrated organizational skills and the ability to prioritize workload.
Demonstrated ability to deliver presentations to external clients.
Demonstrated ability to work independently and as part of a team.
Demonstrated ability to work under pressure to tight deadlines while providing excellent client service in sometimes confrontational situations.
Client Service Orientation
Planning, Organizing and Follow Up
Very Important Competencies:
Communication - Written and Verbal
Screening decisions are based on information outlined in your resumé and cover letter. Your work performance must be satisfactory for your application to be considered. If applying for or out of a term position, please note that article 10.09d of the Collective Agreement may apply.
You may be asked to demonstrate your ability through competency based interviewing and/or testing.
Training class is scheduled to begin on Monday, October 15, 2018. Training class is scheduled from Monday-Friday 8:30-4:30. NOTE: Participation in Compressed Work Week or a Flexible Work Hours schedule will be suspended during a training class and no extended vacation time will be permitted.
Please include a cover letter with your resume wherein you identify how your education, skills and/or experience align with our position requirements.
Please note that this position will begin on October 15, 2018 with an 8-week training class. Training class is scheduled from Monday-Friday 8:30-4:30. NOTE: No extended vacation or time off will be permitted.
Ability to communicate proficiently in both official languages (English & French) is an asset.
A satisfactory criminal record check and verification of education will be required for the successful candidate.
The WCB is committed to building a skilled, diverse workforce with equitable representation of Indigenous persons, visible minorities, persons with disabilities, women, LGBTTSQ+ persons and members of other equity-seeking groups. Applicants are encouraged to indicate in their covering letter or resumé if they are a member of these groups.
The Workers Compensation Board of Manitoba welcomes and encourages applications from people with disabilities. Accommodations are available on request for candidates taking part in all aspects of the selection process.
The Workers Compensation Board promotes safety and health in Manitoba workplaces and aims to help prevent and reduce the occurrence of workplace injuries and disease. Working with its partners, the WCB promotes safe and healthy workplaces, facilitates recovery and return to work, provides compassionate and supportive compensation services for workers and employers, and ensures responsible financial stewardship.
WCBdoes encompasses what it means to work at the WCB. The WCB is proud to have employee benefits and programs that support financial and personal security, foster health and well-being, encourage involvement and support growth as an individual and member of the WCB community. The four categories of WCBdoes include: Security, Wellness, Engagement and Growth.
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