Job Description

Disability Claim Specialist (Complex Claims & COD)

Location: Hybrid - Kingston or Toronto, ON

Empire Life is looking to hire a Disability Claim Specialist (Complex Claims & COD) to join our Group Operations team!

The Disability Claim Specialist is a senior subject matter expert responsible for the proactive and strategic management of complex long-term disability (LTD) claims, with a strong focus on cases approaching or undergoing a Change of Definition (COD) from "own occupation" to "any occupation." As a key member of the active claims team, this individual provides expert consultation, mentorship, and direct case management to ensure claim decisions are sound, fair, and aligned with policy provisions and organizational best practices. This role is critical in mitigating financial and legal risk, driving service excellence, and enhancing the overall capabilities of the disability claims team.

Why pursue this opportunity

Impactful work - get the opportunity to work on meaningful projects that have a positive impact on our customers, our company, and society as a whole.

Play an integral role - this is an opportunity that allows for you to grow your skills, while directly contributing to the business unit you are a part of.

Deliver excellence - provide a personal, accurate, professional, and courteous service and resolution to our customers.

Diversity, equity, and inclusion - we are committed to creating a diverse, equitable, and inclusive workplace and welcome candidates who share this commitment.

What you’ll be working on

1. Expert Claim Adjudication and Strategy:

• Proactively manage/support a dedicated portfolio of high-complexity LTD claims, including those with significant medical, vocational, or contractual challenges.
• Support the Change of Definition process by coaching and signing off on Change of Definition milestones, determining a claimant's capacity to engage in "any occupation" based on their education, training, and experience.
• Develop and execute comprehensive case management strategies, utilizing medical, vocational, and other expert resources/vendors to ensure objective and well-supported claim decisions.
• Drive a culture of early intervention to provide best claim outcomes
• Expertly manage and adjudicate claim appeals, conducting thorough and impartial reviews of new evidence, including sound documentation and communication of the decision

2. Team Leadership and Mentorship:

• Serve as the primary resource and subject matter expert for Disability Case Managers on all matters related to Change of Definition and complex claim files.
• Provide coaching, technical guidance, and mentorship to team members to build their skills in assessing transitional skills, labour market analyses, and vocational rehabilitation potential.
• Lead team sessions to review complex files, offering strategic direction and fostering a collaborative, knowledge-sharing environment.
• Conduct quality assurance reviews on COD files and complex claims to ensure consistency, accuracy, and adherence to best practices.

3. Data-Driven Analysis and Reporting:

• Analyze claim data to identify trends, patterns, and risk factors associated with COD claims.
• Develop and maintain reports on COD outcomes, including return-to-work successes, claim resolutions,, and appeals, providing insights to leadership.
• Leverage data to recommend process improvements and inform departmental strategies for managing LTD Claims.

4. Service Excellence and Communication:

• Communicate complex claim decisions and rationale with empathy, clarity, and professionalism to claimants, employers, and other partners.
• Effectively manage sensitive and potentially contentious claim situations, utilizing advanced negotiation and conflict resolution skills.
• Collaborate with internal and external partners, including legal counsel, medical consultants, and vocational rehabilitation specialists, to achieve optimal claim outcomes.

What we’re looking for you to have

• Bilingualism in French and English is an asset
• 5-10 years of experience managing LTD claims
• Undergraduate degree in kinesiology, anatomy, biology, life sciences, rehabilitation, psychology, or related.
• LOMA 280, 290, HIAA, CEBS - GBA are assets
• Claims Management Expertise: Deep knowledge of disability claims, including the ability to manage complex cases, understand policy language, and navigate legal or medical complexities. Experience with appeals and escalations is critical.
• Analytical and Problem-Solving Skills: The ability to analyze data and trends to identify root causes of issues, evaluate complex claims, and make sound recommendations. This includes proficiency in identifying process improvements and knowledge gaps.
• Leadership and Mentorship: Experience in coaching, mentoring, and providing constructive feedback to peers. The role requires the ability to serve as a subject matter expert, conduct sign-offs, and guide professional development.
• Communication Skills: Strong written and verbal communication is essential for leading discussions, providing clear recommendations to managers, and coaching team members.
• Organizational Skills: The capacity to manage a caseload, proactively review claims at specific intervals, and support the day-to-day activities of a team.
• If you are applying for a position which is open to applicants across Canada, unless otherwise indicated in the position, language proficiency in English is required for communicating with customers, advisors, or employees across Canada.

Beyond the salary

For permanent full-time positions, Empire Life offers a comprehensive total rewards package that includes:

• Competitive salaries with annual pay increases
• Annual bonus program, which recognizes both strong company performance and individual contributions, for non sales positions
• Competitive uncapped commission, for sales positions
• A comprehensive employer-funded benefits package starting from day one of employment, that includes life insurance, disability, health and dental and a generous health account
• Flexible work arrangements and an annual allotment of personal health days.
• Four weeks annual vacation from hire date
• A defined contribution pension plan with generous employer matching
• Top up programs for parental leave and compassionate leave
• Employer-sponsored wellness and recognition programs
• A cash employee referral program

To learn more about working at Empire Life, visit .

Get to know us

Empire life is proud to be an equal opportunity employer. We celebrate diversity, are committed to creating an inclusive environment, and welcome everyone to participate in our application process.

We encourage those of all backgrounds and experiences to apply, even if you don't believe you meet each unique qualification outlined. Applicants will receive equal consideration without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, disability, or age.

Empire Life welcomes applications from people with disabilities and disabled people. Accommodations are available upon request for candidates taking part in all aspects of the screening and selection process. If you need this job posting in an alternative format or have any accessibility questions, please contact recruitment@empire.ca .

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