Eligibility Specialist

About WCB On behalf of WCB Nova Scotia, Venor is recruiting for an Eligibility Specialist. By working to keep Nova Scotians safe, healthy, and on the job, and supporting them when their lives are impacted by workplace injury, WCB Nova Scotia is contributing to a safer, stronger province. We provide workplace injury insurance to approximately 19,500 employers and 335,000 workers across the province. Our vision is a Nova Scotia safe and secure from workplace injury. WCB Nova Scotia is consistently recognized as a Top Employer in Atlantic Canada and Nova Scotia and has also been recognized nationally as a Top 100 Employer and as one of Canada’s Most Admired Corporate Cultures. The Eligibility Specialist adjudicates medium and complex claims by securing all critical information from relevant parties to determine claim eligibility. The Eligibility Specialist investigates root causes by following methodical procedures to collect evidence, interview witnesses, gather statements, and review organizational policies and other relevant documentation. This work includes investigative interviewing and in-depth analysis, interpreting conflicting and unfamiliar information, and liaising with healthcare providers, workers, employers, coworkers, agencies, union and lawyer representatives. They may also liaise with external providers to collect and analyze comprehensive investigation reports and assessments. The Eligibility Specialist weighs the evidence to make the initial entitlement decision and, working closely with the Navigator, clearly and compassionately communicates the decision rationale and applicable policy /legislation to workers, employers, and their representatives. This role works to prevent and resolve disputes, handle requests for reconsideration, and arrange the next steps to process any objections/appeals as required. The Eligibility Specialist refers accepted claims to the Case Manager for overall case management services that include, but are not limited to, arranging treatment, timely and safe return to work planning, and overall goals for claim resolution. This role provides exemplary, timely, and compassionate service to all clients, ensures fair and impartial adjudication, and fosters professional, empathetic, and collaborative working relationships. About You As a successful Eligibility Specialist, you will possess a university degree in health care, education, or social sciences and 4 years of experience performing medium or complex case management in a decision-making capacity in patient care, social service, health care, insurance, disability case management, or related environment, or applying law and/or policy to make complex determinations. Prior experience in investigative work is preferred. (Note: an equivalent combination of a university degree in another area of study and significant additional relevant experience may be considered). As safety champions, all employees are responsible for following safe work procedures; using personal protective and safety equipment as required; knowing and complying with all regulations; reporting any illness or injury immediately to their manager; reporting unsafe acts and unsafe conditions; and cooperating with occupational health and safety initiatives. We are a scent-reduced environment. WCB Nova Scotia champions safety and promotes a diverse and respectful workplace.  The Offer We offer a competitive compensation package including a salary range of $69,723 -$87,095