Accident Benefits Claims Representative - ll

Portage Mutual Careers Centre•Edmonton, AB

6d•CA$64,000 - CA$80,000•Hybrid

About The Position

Portage Mutual Insurance is a trusted national property and casualty insurer, serving policyholders since 1884. As a policyholder-owned company, they offer competitive home, auto, commercial, and farm insurance products through a broker network across Canada. They pride themselves on a tradition rooted in innovation and a people-first culture. This role is for an Intermediate Accident Benefits Claims Representative who will investigate, evaluate, reserve, negotiate, and resolve assigned automobile accident benefits claims. The representative will be responsible for reviewing new losses, developing investigation plans, gathering necessary documentation, and applying regulatory classifications. They will communicate with various stakeholders to assess injuries and financial losses, determine claim eligibility, and utilize systems like HCAI, dispute resolution techniques, structured settlements, and independent medical exams to ensure fair and timely claim outcomes. The ideal candidate is detail-oriented, enthusiastic, a team player, and embodies company values while providing top-notch service.

Requirements

Minimum of 3-5 years experience with auto physical damage adjusting, in a medical professional office, and in a role dealing with accident benefit claims.
Proficient in Microsoft Office Suite and relevant claims systems (e.g., Guidewire), with the ability to adapt to new technologies.
Consistently applies accuracy, thoroughness, and meticulousness in all aspects of work.
Strong critical thinking and problem-solving skills to assess the strengths and weaknesses of each claim within authority limits.
Excellent verbal and written communication skills.
High level of confidentiality.
Ability to work independently or as a collaborative team and is self-motivated to work in a fast-paced changing environment.
Post secondary education in business, nursing, health care aid, insurance or medical reception.
CIP designation completed, actively in progress, or willing to work towards.

Responsibilities

Review new losses, prepare an investigation plan, and contact the insured to discuss loss details.
Work with policyholders to explain claims process in a clear and concise manner to ensure an efficient claims experience.
Secure statements with policyholders, third parties, independent witnesses, passengers as necessary.
Secure medical authorization, statutorily required forms, and medical opinions as necessary.
Arrange appropriate independent medical examinations to aid in the assessment of coverage, injuries and damages.
Assess the need and retain licensed investigators to assist in understanding injury severity.
Work with accountants to assess income and other financial losses related to accident benefit coverages.
Review complex policy wordings and legislation to assess coverage eligibility.
Communicate verbally and in writing to policyholders and brokers coverage positions.
Review complex medical forms and reports to determine benefit payment eligibility.
Negotiate settlements based on results of loss investigation, coverage analysis and damage assessment within authority limits.
Complete ongoing follow up communication per corporate service standards with all file stakeholders to bring claim to resolution.
Attend industry events to network with brokers and vendors in a manner that portrays Portage Mutual Insurance in a positive light.