Appeals Specialist

Position Title: Appeals Specialist
Reports To: Manager, Life STD LTD Claims
Department: Group
Term:  Permanent Full-Time

Work Arrangements: This is a hybrid role. You will work in our office in Waterloo, ON a minimum of two (2) assigned, consecutive days every other week, plus a fifth (5th) assigned day per month. You are welcome to work from the office more than the minimum requirement and there may be some roles that are required to work in our office more than the minimum requirement.

 

The Opportunity: Equitable is growing! We are looking for a Appeals Specialist to join our Group Claims Team! This team member will be responsible for assessing short- and long-term disability claims where the decision to terminate benefits has been appealed by the plan member. Now is an exciting time to join one of the Waterloo Area’s Top Employer for 2025 and Southwestern Ontario’s Top Employers for 2024!

What you will be doing:

• Analyze medical, functional, employment and contractual information in order to make timely and accurate decisions on appealed STD and LTD claims
• Provide coaching support to the Disability Claims Specialist (DCS) to ensure all necessary information and action has been taken on each file
• Frequently communicate with plan sponsors, plan members, advisors, and other professionals as required
• Track and monitor appeals data; assist in setting appropriate targets to measure effectiveness of progress and success
• Assist in developing the best practice resources related to the appeals process
• Collaborate with the best practice team and claims managers to identify trends and opportunities for improvement; assist leadership team with coaching and claim reviews as required
• Handle all access requests within required timelines
• Assist Senior Litigation Consultant with subrogation and file preparation for litigated files as required
   
   

What you will bring:

• Superior case management and problem solving/decision making skills
• Demonstration of our Service First Principles (empathy, demonstrate expertise, easy to do business with, take ownership, treat everyone fairly)
• Exceptional written communication skills to help shape letter writing practices
• Ability to deliver constructive feedback in a tactful and effective way
• Strong knowledge of group disability insurance and policy provisions
• Process improvement mindset
• Comfort with ambiguity and desire to shape new practices and processes
• Flexibility to assist team where required
• Ability to proactively manage a fluctuation and unpredictable workload
• Work experience in Short Term Disability and Long Term Disability is required

What’s in it for you:

• A healthy work-life balance with employee wellness top of mind
• Annual bonus program, annual vacation allowance, and company-paid benefits program
• An additional paid volunteer day each year so you can spend time giving back to the community
• Immediate enrollment in the company’s pension program with employer matching
• Employee resource groups that support an inclusive work environment
• Tuition support and specialized program assistance
• An onsite full-service cafeteria with a variety of daily options
• Discounts on company products and services, and access to exclusive employee perks
• Regular EQ Together events focused on company togetherness and collaboration

As part of the recruitment/offer process you will be required to:

• Provide two professional references (minimum one supervisor and above)