Business Rules Specialist (HYBRID)

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 and may be eligible to participate in our health and dental plan.

Salary Grade: 213 From: $94,583.02

Temporary assignment up to 12 months in duration.

Job Summary

Act in a technical capacity to lead end-to-end business rule development process by designing, building, testing, implementing solutions, and production support.

As a subject matter expert, working in collaboration with a variety of stakeholders, business partners, and others in various roles including management team to provide recommendations and propose solutions to improve business efficiency and provide support for new and redesigned healthcare projects. Providing client support for all business rule related queries.

Analyze complex billing issues raised by internal or external stakeholders and provide explanation, resolution, and instructions.

Identify trends and emerging issues that may impact on rising costs or business processes and evaluate the impact on WSIB’s Health Care/Return to Work business.

Major Duties And Responsibilities

• Provide technical expertise and leadership in the design, development of business/billing rules that adhere to quality management and development standard for various WSIB projects.
• This includes:
• Analyzing business requirements and perform impact analysis.
• Participating in contracted/non-contracted program development and implementation.
• Providing detailed solutions to business/technical issues and ensure that design meet business requirements and that development schedules are also met.
• Providing solution recommendations that have potential business/process automation impact and organization/financial impact by providing walkthrough summary of solutions/options to stakeholders, which includes proposed process changes and impact to business area.
• Mentoring and coaching to team members in the areas of Development and Integration.
• Providing leadership and coordination to internal and external business areas.
• Researching development and integration best practices and introduce innovative and creative time saving solutions.
• Use proprietary programming/scripting language, combined with a knowledge of other programming/scripting languages (such as C/C++, Java Script, SAS, SQL, etc.) in order to create products and services that will enhance the experience of the external provider’s billing process and reduce financial risk to WSIB.
• Create functional and hard coded query calculations, develop a clear understanding of the relationships within HSM, and develop, update, debug, and test rules, calculations and expressions
• Write complex queries to ensure data is easily accessible, runs efficiently and optimizes the performance of the WSIB's system wide HSM billing solution
• Interact with the business, vendors and ITC technical teams by:
• Defining and maintaining business rule software development/Fee Schedule/integration standards and guidelines that meet industry best practices.
• Providing feedback to high-level solution designs, project plans, requirements, testing and change/implementation review and walkthroughs.
• Identify integration issues and collaborate on system solutions regarding confidential data/information and transfers between WSIB and service providers.
• Engaged in system installations and software testing.
• Conducting and leading technical and detailed design walkthroughs and code reviews.
• Functioning in a support capacity to provide isolation and resolution of software issues by leading root cause analysis, providing recommendations and communicating options for resolution of software issues.
• Develop and execute complex data queries in order to extract and compile data and build reports using Cognos, Access, and Excel in order to inform planning, decision-making, and reviews related to programs, initiatives, strategies, services, processes, and metrics.
• Automating manual payment processes to improve efficiency/productivity/accuracy for Health Care Payment area.
• Act as an internal expert resource to internal and external clients on the impacts and financial risks of proposed rule changes and consult with clients to ensure they understand the relationships between existing and proposed business rules. Liaise and communicate with internal and external clients to inform them of new or changed business rules or processes. Define guidelines for billing rule development to ensure quality and adherence to development best practices.
• Participate in the vendor relationship by:
• Managing and facilitating the change request process from beginning to end; analyzing the viability and priority of change requests against business need and provide recommendations to Senior Management
• Monitoring change requests ensuring agreed upon timelines are delivered and solution development and implementation schedules are met by the vendor;
• Ensuring that the quality of the delivered solution meets WSIB expectations and resolves the business issue/need; monitoring the service level agreement
• Facilitates a joint Review Committee on the solution as it relates to business rules
• Maintain liaisons with internal and external clients on issues/problems; establish and maintain quality assurance processes and controls to help identify possible irregular activity and ensure proper controls are in place to maintain the integrity and currency of HSM.
• Partner with ITC to monitor the integrity of HSM by:
• Identifying and resolving system problems related to business rules;
• Ensuring all health care/return to work rules and on-line fee schedules are current and operational;
• Planning, co-ordinating, testing, and implementing changes to rules.
• Collaborate in branch or cross-divisional projects by:
• Providing expertise and documentation relating to business rules and related processes;
• Supporting with establishing action points, developing work plans, assembling the team, and delegating responsibilities;
• Lead implementation by advising clients and designing business rule changes;
• Supporting with monitoring project progress and providing direction to project team members.
• Partner with Learning and Development/Operations to assist in identifying staff learning requirements/opportunities, to provide feedback on learning evaluation, and to ensure HSM payment processing and rules administration training is current and accurate. Develop and deliver training sessions and documentation to support staff learning.
• Perform other related duties as required or assigned.
  

Job Requirements

Education

• University completion at undergraduate level with a specialty focus in mathematics, statistics, computer science, business administration, engineering, information management or science.
  
  

Experience

• Five years prior experience in programming and/or software development with at least two years’ experience within adjudication or health care or business analysis or insurance or IT.
  
  

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 [email protected] .

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 [email protected] . 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.