Curo - Accident Benefits Claims Examiner

OTIP Group of Companies (OTIP, Orbit, Curo) • Waterloo, ON

78d • CA$57,669 - CA$79,295 • Hybrid

About The Position

The Accident Benefits Claims Examiner is responsible for assisting insured members through Statutory Accident Benefits injury rehabilitation programs and the resolution of minor to moderate claims. This includes establishing a prompt relationship with insured members and their legal representatives and assessing quantum while ensuring fiduciary, regulatory and contractual compliance, adhering to organizational service standards, operational targets and core competencies.

Reporting to the Senior Manager, National Injury, the core parts of your role will be to:
Deliver a superior customer experience which includes responding to all general inquires, initiating and maintaining contact with insured members, and assisting with commodity claims overflow.
Review and determine eligibility for Statutory accident benefits by gathering information from insured members, health practitioners, employers, police, claimant’s lawyers, accountants, and other insurers or programs with income continuation plans relating to minor to moderate claims.
Make decisions by considering all information and consulting with legal and medical experts when required.
Maintain quality service and adheres to organizational standards to deal with all aspects of file handling, including reserving, expense and loss control, questionable claims, and creating defined disposition plans for future handling leading to file closure.
Assist senior AB team members in Arbitration and License Appeals Tribunal proceedings and prepares documentation for case conferences and hearings on behalf of key stakeholders. Provides support and assembles documentation on benefits being disputed along with resolution recommendations.
Keep claims information confidential to protect operations and insured members.
Responsible for data integrity, issuance of payments to vendors, insureds and experts and maintaining well-organized claim files while ensuring accuracy of inputted data.
Adhere to partner's guidelines, contracts, and insurance regulations to ensure legal and regulatory compliance.
Actively participate in coaching and training sessions and collaborates with team members and management.
Take an active role in creating an environment of continuous improvement of work efficiencies and highlighting value work.
Perform other duties within competence, as assigned.

Requirements

• A post-secondary education and/or college diploma within related field
• CIP designation or working towards designation.
• An All-lines Adjuster’s license in Ontario and Alberta (Level 2 minimum).
• 3+ years’ experience with a good understanding of both Ontario and Alberta in accident benefits.
• 2 years’ experience in all lines claims adjusting.
• Excellent communication skills verbal and written to effectively work with internal and external stakeholders.
• Strong time management and organizational skills to manage competing priorities.
• Current Microsoft Office working knowledge
• Ability to learn and adapt in a fast-pace environment including working with various computer programs, databases and software.
• Ability to work independently and as part of collaborative team environment

Nice To Haves

• Experience and knowledge in injury claims medical rehabilitation concepts and medical terminology is preferred.
• The ability to communicate in French is asset.

Responsibilities

• Deliver a superior customer experience which includes responding to all general inquires, initiating and maintaining contact with insured members, and assisting with commodity claims overflow.
• Review and determine eligibility for Statutory accident benefits by gathering information from insured members, health practitioners, employers, police, claimant’s lawyers, accountants, and other insurers or programs with income continuation plans relating to minor to moderate claims.
• Make decisions by considering all information and consulting with legal and medical experts when required.
• Maintain quality service and adheres to organizational standards to deal with all aspects of file handling, including reserving, expense and loss control, questionable claims, and creating defined disposition plans for future handling leading to file closure.
• Assist senior AB team members in Arbitration and License Appeals Tribunal proceedings and prepares documentation for case conferences and hearings on behalf of key stakeholders. Provides support and assembles documentation on benefits being disputed along with resolution recommendations.
• Keep claims information confidential to protect operations and insured members.
• Responsible for data integrity, issuance of payments to vendors, insureds and experts and maintaining well-organized claim files while ensuring accuracy of inputted data.
• Adhere to partner's guidelines, contracts, and insurance regulations to ensure legal and regulatory compliance.
• Actively participate in coaching and training sessions and collaborates with team members and management.
• Take an active role in creating an environment of continuous improvement of work efficiencies and highlighting value work.
• Perform other duties within competence, as assigned.

Benefits

• Defined benefit pension plan for a financially confident retirement
• 100% coverage of approved continuing education and licensing fees
• Access to a wealth of learning resources, including LinkedIn Learning for professional development
• Flexible work-from-home and hybrid options
• Opportunities for advancement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree