• Codes and enters imaged claims and triages adjustments, submitted by members, providers and vendors. • Reviews and corrects on-line edit errors by interpreting generated warning messages. • Uses appropriate systems to research and accurately process claims. • Researches appropriate reference documents and imaged claims to make coding and payment decisions. • Reviews and processes claims that are in a pended status in accordance with processing procedures, policies and current contract specifications regarding coverage, contract limitations, and exceptions. • May identify and report possible system or Image problems to CPR or Supervisor so that corrective action may be taken. • All other duties and assignments as directed.

• Evaluate appropriateness of beneficiaries' admission to nursing facilities • Verify documentation of medical necessity for prior approval requests • Meet performance expectations by completing at least 40 prior approval reviews daily • Achieve quality assurance reviews with greater than 95% accuracy • Complete timely reviews within 24 hours

• Utilize various software platforms including AS400, Microsoft Office Suite (Outlook, Word, Excel), Adobe PDF, ISO, CARFAX, Winloan, and Claimtrak to perform daily tasks. • Establish and maintain effective communication with customers and all parties involved in the claims process. • Gather and prepare all necessary documentation to support claim resolution. • Analyze loan transaction history to verify payments, fees, and insurance details. • Review waivers to determine coverage eligibility, calculate claim amounts, and submit for final review. • Document all correspondence and claim-related information in AS400. • Monitor and follow up on pending claims using the GAP pending claims (AWP) list. • Apply strong decision-making and organizational skills to manage multiple claims efficiently. • Deliver exceptional customer service and clearly explain complex insurance policy terms. • Use auto valuation tools such as CCCOne, Mitchell, Autosource, and Kelley Blue Book to assess vehicle values. • Meet departmental quality standards and achieve service level and production goals.

Role Description We’re hiring a Workers’ Compensation Case Manager for an 18-month maternity leave contract . This is a full-time, fully remote opportunity and a chance to step into a well-established portfolio where you can make an immediate impact. In this role, you will represent our client’s interests while ensuring claims are managed efficiently, thoughtfully, and in compliance with Workers’ Compensation legislation and policies. Your work will focus on supporting safe and timely return-to-work outcomes, managing claim costs responsibly, and building strong, trusted client relationships. You will report directly to the Director of Claims Management. What You’ll Be Doing - Manage Workers’ Compensation cases in accordance with legislation, policies, and procedures - Identify cost recovery, containment, and avoidance opportunities - Maintain strong working relationships with clients and Workers’ Compensation Boards - Prepare clear, timely reports for clients, provincial boards, and other stakeholders - Facilitate client meetings, on-site consultations, and ongoing communication - Complete employer reporting forms accurately and on time - Prepare objections and appeals, representing employer interests - Communicate with injured workers, develop return-to-work plans, and attend case meetings - Meet client service, satisfaction, and billing objectives - Support new business and revenue growth opportunities where applicable Qualifications - A college diploma or university degree in Paralegal Studies or a related field such as Business, Social Sciences, or Administration - At least three years of experience in adjudication and case or claims management within a Workers’ Compensation environment - Experience interpreting legislation and applying statutory principles - Professional development related to Workers’ Compensation and related legislation - Experience navigating appeal processes, including representation at the TAT - At least three years of experience in return-to-work planning and facilitation Requirements - Disability management experience - Strong understanding of the financial impact of claims - Fluency in both French and English Work Schedule - Full-time, 37.5 hours per week - Monday to Friday - Fully remote - 18-month maternity leave contract Benefits Kii Health is an equal opportunity employer. We are committed to building a diverse and inclusive workplace where everyone feels valued and supported. We do not discriminate on the basis of race, ancestry, religion, color, national origin, gender, gender identity or expression, sexual orientation, political belief, age, marital status, or disability. We are also committed to providing an accessible recruitment process. If you require accommodation at any stage, please contact recruiting@kiihealth.ca . The safety and wellbeing of our employees, clients, and patients is important to us. Final candidates will be required to complete a background check.