Our people have different ways of working and lifestyles. We’re committed to a mix of working in the office, in the field and from home. You have some flexibility in terms of where and how work gets done to help you balance your personal life and career goals.
About the Workplace Safety and Insurance Board (WSIB)
We’re here to help. When an injury or illness happens on the job, we move quickly to provide wage-loss benefits, medical coverage and support to help people get back to work. Funded by businesses, we also provide no-fault collective liability insurance and access to industry-specific health and safety information. We are one of the largest insurance organizations in North America covering over five million people in more than 300,000 workplaces across Ontario. For more information, visit wsib.ca.
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.
Salary From: $71,720.18
Job Summary:
As a member of a provincial team, review and critically analyze claims that have been approved for the payment, or adjustment of wage replacement and related benefits, leveraging knowledge of Legislation, Operational Policies and guidelines in order to determine, calculate and process the benefits in a timely and accurate manner. This includes contacting any Workplace Parties and Case Owners to request and/or clarify necessary earnings information.
Provide support to Case Owners as well as Workplace Parties in addressing or interpreting complex benefit decisions and their outcomes. Responsible to determine the appropriateness of a Long-Term Rate (LTR) recalculation of wage replacement benefits in accordance with Operational Policy, requesting and assessing earnings information from Workplace Parties, calculating rate of benefits, communicating decisions and reconsidering any related objections.
Major Duties and Responsibilities:
1. Validate the accuracy of benefit payment authorizations received from Case Owners and in cases determined by eAdjudication; take appropriate action including determining the earnings basis according to current and previous applicable legislation and operational policies before processing payments in various WSIB systems by:
- Contacting workplace parties to obtain and verify information including but not limited to: earnings information, lost time, modified duties, and document other employer questions/concerns raised and refer to decision makers to review. Documents this information in order to complete earnings calculation, process LOE benefits for the correct period, per e-Adjudication guidelines
- Ensures the claim is directed to the proper operations area and the necessary administrative activities are assigned depending on the appropriate RTW scenario as outlined in e-Adjudication payment process
- Identifying, investigating, analyzing, and cross referencing related documentation in the claim file to determine if the information is sufficient prior to processing the payment
- Contacting the workplace parties (WPPs) and/or Case Owner to obtain or clarify required information regarding earnings or return to work information; determining and setting a suitable temporary rate and requesting further earnings information required to adjust temporary rate when established by the Payment Specialist
- Conferring with Case Owners to determine appropriate course of action with respect to payments; returning file to Case Owners for further action including a detailed memo explaining the information or action required
- Consulting with the manager for complex payment problems such as removal of interest charges for accident cost, manual and demand cheques, unusual payments and complex system workarounds
- Determining cases that require a recalculation of wage replacement benefits to a long-term rate (LTR) and determining the employment pattern of the injured person (permanent / non-permanent / exceptional situations) to ensure the correct earnings are requested for the Long-term Rate (LTR) Calculation in accordance with operational policy and guidelines;
- Following up to identify and request the necessary earnings information in writing from the WPPs for the recalculation and implementation of the LTR, if applicable. LTR recalculation decisions are communicated in writing to WPPs and representatives.
- Reconsider LTR decisions and short-term rate calculations in response to receipt of additional earnings information or objections from WPPs, processing adjustments and preparing related documentation and communication of decisions to WPPs, and where required, work with Case Owners to prepare the claim for a referral to the Appeals Branch
- Calculating, communicating, prorating and ensuring funds are directed to appropriate payees such as: accident employer, HRSDC, Social Services, court orders, Canada Revenue Agency requirement to pay garnishments, third party insurance providers, other employers etc.
- Calculate and process Pre-90 Pension / Supplements (OAS and Bill 165)/TT and Bill 162 benefits (FEL / Supplements / TT), apply system workarounds and ensure accurate interpretation and implementation of WSIAT decisions with regards to wage replacement and related benefits;
- Process NEL benefits and related accident cost adjustments
- Process and adjust Survivor benefits such as Burial cost reimbursements, Lump Sum benefits and ongoing support benefits
- Complete LRI reconciliations and adjustments (if necessary) as requested by LRI Department
- Manually calculating the rate of compensation to coincide with system parameter calculations, excess interest, minimum and maximum payouts, escalation criteria in Pre Bill 101 claims, and appropriate policies, rules and regulations
- Creating payment transactions and adjustments and documenting required information for all entitlement authorizations including exercising delegation of authority to self-release payments up to $29,999.99 for each file; taking corrective action in cases of inaccurate transactions including communicating to the necessary departments
- Work with management to review daily, weekly, monthly, quarterly and yearly system reports that show cheque errors, manual cheque lists, indexing errors, and ensure the accuracy of payments is maintained.
- Clarify missing or unclear direction from garnishment administrator on garnishment of benefits
- Notify Treasury of request to pull and cancel cheques and apply credits to accident cost for manual transactions.
- Cancel, place stop-payment, reissue of cheque/direct deposit that are returned, outstanding, purged, void. Ensure accurate processing while using PRCM function (High Risk screen) to reissue stale-dated cheque or creating appropriate overpayment
- Updating the worker / payee profile (date of accident, date of birth, date of death, gender (when required)
- Promote the use of e-services and online services
- May be required to engage with management on identifying gaps in training, process or policies to help drive improvement
2. Provide specialized technical advice and assistance by:
- Providing knowledge and guidance for the application of payment matters such as policies and procedures, changes as a result of legislation, Worker Benefit System (WBS) and Survivor Benefit System (SBS), Guidewire and manual interest calculations (via TSOD) for Case Owners, Return-to-Work Specialists (RTWS), Customer Service Representatives (CSRs), and all other WSIB employees
- Responding to requests for information from Case Owners, such as the correct application of benefit payment legislative policies and procedures
- Responding to enquiries from WPPs and representatives related to correct application of benefit payment legislative policies and procedures in appropriate cases
- Providing assistance, support, and mentoring when checking the accuracy of work for staff trained in new skills sets (existing and new Payment staff) and providing verbal feedback to the manager, as required
- Provide technical advice and support to Case Owners regarding financial and tax information, issues relating to evaluating benefit coverage, employment pattern and earnings calculation for self-employed workers
- Provide guidance to Case Owners on setting up a temporary rate based on the review of the file and to lessen the potential of an overpayment when benefits are adjusted
3. Document payment histories, provide benefit/payment status, and provide detailed written explanations of adjustments and overpayments on work completed or in response to enquiries and provide detailed calculations to WSIB management, Case Owners and WPPs verbally and in writing by:
- Comparing benefit authorizations and dates against actual payments, assessing differences, and adjusting as require
- Reporting and documenting case information to required and authorized staff members
- Completing templated and custom letters outlining the necessary information, adhering to privacy guidelines for WPPs
- Reviewing and confirming all funds issued in a claim in response to the receipt of Board Expense Memos (BEM) from the Legal Services Department
4. Verify accuracy of payment histories transferred from previous systems and convert or recreate histories where required by:
- Reviewing claim file to ensure all payments and periods are accounted for, ensuring accuracy of all entries on all payment data; clarifying earnings information in claim file with Case Owners or Employer
- Ensuring accuracy of earnings basis used to process payments in initial or re-opened claims; ensuring correct application of all amendments; recreating overpayments that were not converted from previous systems; correcting or creating payment history as required
- Making corrective adjustments to resolve case issues
- Completing DBAID requests for appropriate system corrections
5. Calculate and process interest owing on delayed payments resulting from Appeal Resolution Officers or Workplace Safety Insurance Appeals Tribunal (WSIAT) decisions by:
- Determining differences in dates, earnings rates, and types of awards based on the decision
- Determining the interest payable using a combination of manual calculations and system tools (TSOD); creating payment transactions or complete the manual cheque payment process
- Reviewing to determine if charges to the employer account must be adjusted and notifying Accident Cost and Schedule 2 accident employers where required
- Providing instructions to the Treasury Department to adjust accident cost if needed
6. Maintain statistics on all aspects of work processed, reviewing and monitoring case load progress, and assisting on projects to develop clear and concise payment service methodologies
7. Correct or update data on all systems according to payment services production output reports and report system inconsistencies to the manager
8. Promote the values and principles of the WSIB during phone calls with WPPS and ensure phone software is updated with the applicable claim detail data
9. Performs other related duties as required or assigned
Job Requirements:
Education
- High school completion and certificate program of up to one year in accounting, bookkeeping, payroll, mathematics or finance.
Experience
- Total of four years and two months experience. One year prior experience in financial /mathematical concepts.
Our commitment to equity, diversity and inclusion
We respect and value the diversity of our people. We strive to create an environment where employees can be themselves and where our differences are celebrated.
The WSIB is committed to being accessible and inclusive, and following barrier-free and accessible employment practices in compliance with the Accessibility for Ontarians with Disabilities Act (AODA). Should you require accommodation through any stage of the recruitment process, please let us know when we contact you and we will work with you to meet your needs.
Disclosing conflicts of interest
As public servants, employees at the WSIB have a responsibility to act in an ethical way at all times to create a respectful workplace and maintain public trust. Job applicants are required to disclose any circumstance that could result in a real, potential or perceived conflict of interest. A conflict of interest is any situation where your private interests may impair or be perceived to impair the decisions you make in your official capacity. This may include: political activity, directorship, other outside employment and certain personal relationships (e.g. with current WSIB employees, customers and/or stakeholders). If you have any questions about conflict of interest obligations and/or how to make a disclosure, please contact the Talent Acquisition Centre at talentacquisitioncentre@wsib.on.ca.
Privacy information
We collect personal information from your resume, application, cover letter and references under the authority of the Workplace Safety and Insurance Act, 1997. The Talent Acquisition Centre and WSIB hiring parties will used this information to assess/validate your qualifications, 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, please contact the WSIB’s Privacy Office at privacy_office@wsib.on.ca. The Privacy Office cannot provide information about the status of your application.
As a precondition of employment, the WSIB requires that prospective candidates undergo a criminal records name check any time before or after they are hired.
To apply for this position, please submit your application by the closing date.