Job Summary (external):
In a contact centre environment, acts as the primary point of contact for responding to and resolving claim and coverage related inquiries from workers, employers, representatives, healthcare practitioners, and vendors. This includes conducting follow-up and gathering relevant information to support effective claim management.
Job Duties:
The Claims Service Representative is responsible for creating new claim files, ensuring Workers Compensation coverage, accepting specific no time loss claims, and managing each inquiry to a resolution that provides for customer satisfaction and meets organizational standards and objectives. Uses effective listening and questioning techniques to determine each customer's need(s); identifies, evaluates and determines alternatives to problem solve. When unable to resolve an inquiry prior to the end of the call, takes steps necessary for resolution immediately following the call or arranges for an Adjudicator or Case Manager to resolve on a timely basis.
Follows established procedures to create new claim files, input data, search the database, and verify and collect information by calling for, or requesting reports from injured workers, employers and healthcare providers. Notifies the appropriate internal parties at time of reporting of a serious accident or fatality.
Follows department standards for gathering, reviewing, and assessing information to establish Workers Compensation coverage for new claims, communicating decisions to affected parties where appropriate, and referring to the Supervisor or Assessment Services in cases where further action is necessary.
Accepts no time loss claims (Complexity A) within defined parameters. Claims requiring further investigation or approval are forwarded to Adjudicators for review.
Utilizes each inquiry as an opportunity to address customer concern(s) and anticipate future needs, reviewing outstanding or future claim file tasks when appropriate.
Identifies workers in crisis and refers to an appropriate WCB resource.
Reviews the claim file and approves medical expenses within specified guidelines and authority levels. Manages claim owner approved wage loss issues. Refers inquiries that are highly unusual, complex or above authority levels to the appropriate Adjudicator or Case Manager.
Conducts administrative and information gathering follow up activities to support claim management. This includes coordination with internal service areas, in accordance with established procedures.
Updates claim files as part of each call; clearly documents customer communication including any information gathered, entitlement decisions made, actions taken and claim tasks created.
Provides coverage at the main reception desk.
Completes statistical coding of claims within quality and timeliness standards.
Performs other related duties as assigned.
Qualifications:
Completion of a two (2) year diploma in a related discipline (Business Administration)
Minimum two (2) years' experience interpreting and applying processes and procedures to manage and resolve customer inquiries/concerns
Typing speed of 35 w.p.m. (error rate less than 5%)
Knowledge of customer service principles and practices
Proficiency in the use of personal computers and software in a Windows environment
Excellent customer service skills including the ability to manage potentially confrontational situations with tact and diplomacy
Well-developed verbal and written communication skills to deal with internal and external stakeholders
Ability to interpret and apply processes and procedures including those related to WCB Adjudication and Case Management
Ability to obtain, assess and evaluate information through claim file review, listening and/or questioning in order to problem solve and support decision making
Ability to perform detailed and accurate work in a fast paced environment
Ability to work independently and as part of a team
Customer service experience in a call centre environment including knowledge of call centre telephony and technology would be an asset
Knowledge of advanced communication skills such as active listening and de-escalation techniques would be an asset
Ability to communicate proficiently in both official languages (English & French) is an asset, but is not required
Competencies (internal only):
Essential:
Client Service Orientation
Interpersonal Communication
Analysis/Problem Assessment
Written Communication
Very Important:
Judgment/Problem Solving
Quality Orientation/Attention to Detail
Important:
Teamwork
Additional Information (internal):
Please note that this position will begin on November 2, 2026 with a 9 week training class. Hours of work during the training period are 8:30 a.m.-4:30 p.m. Participation in Compressed Work Week, Additional Day Off (ADO), or a Flexible Work Hours schedule will be suspended during a training class and no extended vacation time will be permitted.
You may be asked to demonstrate your ability through competency based interviewing and/or testing.
Screening decisions are based on information outlined in your resumé and cover letter. Your work performance must be satisfactory for your application to be considered. If applying for or out of a term position, please note that article 10.09d of the Collective Agreement may apply.
The WCB recognizes that individuals may face barriers that hinder their full and equal participation in the workplace, and is committed to providing reasonable accommodation to all employees and candidates who are or may be disabled by one or more barriers in the workplace. Accommodations are available on request for candidates taking part in all aspects of the selection process.
Additional Information (external):
Day in the Life!
Salary range: $60,844 - $78,333
Up to 8 permanent positions
Please note that this position will begin on November 2, 2026 with a 9 week training class. During the period of your training, you will not be eligible to take vacation and hours of work will be Monday to Friday, 8:30 a.m. - 4:30 p.m.
Ability to communicate proficiently in both official languages (English & French) is an asset.
A satisfactory criminal record check and verification of education will be required for the successful candidate.
The WCB is committed to building a skilled, diverse workforce with equitable representation of Indigenous persons, visible minorities, persons with disabilities, women, 2SLGBTQ+ persons and members of other equity-seeking groups. Applicants are encouraged to indicate in their covering letter or resumé if they are a member of these groups.
The WCB recognizes that individuals may face barriers that hinder their full and equal participation in the workplace, and is committed to providing reasonable accommodation to all employees and candidates who are or may be disabled by one or more barriers in the workplace. Accommodations are available on request for candidates taking part in all aspects of the selection process.
Job Summary (internal):
In a contact centre environment, acts as the primary point of contact for responding to and resolving claim and coverage related inquiries from workers, employers, representatives, healthcare practitioners, and vendors. This includes conducting follow-up and gathering relevant information to support effective claim management.
