Appeals Facilitator

Position Summary

We are seeking an experienced Appeals Facilitator to join the Governance team. The Appeals Facilitator will play an integral role in coordinating the approved appeals structure, with a primary focus on policy appeals and a secondary focus on total disability appeals. Policy appeals include coverage appeals for income replacement and general health benefits as well as all claims appeals excluding total disability. Although direct engagement with covered members is limited, the ideal candidate will possess exceptional interpersonal and communication skills. They will provide administrative support to the appeal bodies. Exceptional organizational skills and attention to detail are required to ensure that appeal files are accurately prepared, appeals are heard in a timely manner, and appeal body decisions are actioned appropriately.

The ideal candidate has three to five years of experience interpreting and applying policy, with demonstrated experience working with confidential materials.

Your Key Responsibilities

• Use established protocols to screen appeal requests for the following:
  • Validate individual requesting the appeal is eligible to do so.
  • Determine the operational decision can be appealed.
  • Ensure the appropriate policy/process has been applied and required internal reviews have been conducted.
  • Classify the appeal based on approved criteria.
• Assess appeal submissions, requesting additional information as required.
• Prepare confidential appeal files.
• Schedule appeal body meetings for each appeal body.
• Act as an administrative and technical resource to the appeal bodies e.g., respond to questions of fact, assist in drafting the appeal body's decisions, and communicate the decision in writing to the appellant.
• Action appeal decision, ensuring appropriate parties are advised of decisions and informing them to proceed with payments as required.
• Liaise with operations throughout the appeals process as required.
• Maintain accurate and up-to-date records and documentation.
• Identify opportunities for continuous improvement.
• Prepare reporting as requested.
• Other duties as assigned.

Your Education and Experience

• A degree or diploma in a related discipline.
• Three to five years of related experience,
• Certified Employee Benefit Specialist (CEBS) designation is an asset.
• Experience working with appeal bodies and/or tribunals is an asset.
• Course work from the Foundation of Administrative Justice is an asset.

A combination of education and experience may be considered.

Your Abilities

• Experience working with a quasi-judicial panel or appeal body.
• Superior organizational and time management skills.
• Effective communication skills, both oral and written, with a variety of audiences. Must be able to communicate clearly and concisely.
• Analytical thinking and ability to compile and summarize complex information.
• Creative and intuitive problem solving.
• Ability to organize workflow and priorities independently.
• Experience with interpreting and applying policy and protocols.
• Understanding of group benefits and insurance principles.
• Experience providing support to senior management and board members.
• Experience coordinating a committee.
• Relevant course work is an asset including administrative justice, insurance, privacy, etc.
• Strong computer skills.
• Experience working in a fast-paced environment.

Unique Working Conditions

This position is eligible to participate in the hybrid workforce program.

How To Apply

If you have the required qualifications and would like to become a member of our team, please submit your resume and cover letter. This posting will remain open until the role has been filled.

No phone calls please. We thank all interested individuals, but only those candidates being considered for an interview will be contacted. ASEBP is an equal opportunity employer.

All offers of employment for this position are conditional upon satisfactory background and reference checks, which may include a criminal record check and/or education and employment verification.

Please note that an account will automatically be created for you during the application process if you do not have an ApplicantPro account set up already.