Accident Benefits Claims Representative - lll

Portage Mutual Careers Centre•Edmonton, AB

1d•CA$76,600 - CA$95,800•Hybrid

About The Position

As an Accident Benefits Claims Representative III, you’ll investigate, evaluate, reserve, negotiate and resolve assigned automobile accident benefits claims. This role involves reviewing new losses, developing investigation plans, gathering statements, obtaining necessary documentation (medical records, authorizations, forms), and applying regulatory classifications accurately. You will communicate with policyholders, treatment providers, investigators, accountants, and medical professionals to assess injuries, financial losses, and determine claim eligibility. Utilizing systems like HCAI, applying dispute resolution techniques, and leveraging structured settlements and independent medical exams are key to ensuring fair and timely claim outcomes. We're looking for a detail-oriented, enthusiastic team player who embodies our company values and is committed to providing top-notch service.

Requirements

Minimum 5-7 years experience with injury claims with visibility of more complex.
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.
Ability to work independently or as a collaborative team and is self-motivated to work in a fast-paced changing environment.
Demonstrated leadership skills, with experience in training, mentoring, and guiding team members.
Excellent verbal and written communication skills.
High level of confidentiality.

Nice To Haves

Post secondary education in business, nursing, health care aid, insurance or medical reception preferred.
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.
Mentor junior and intermediate team members and contribute to training, quality, and process improvement initiatives.
Attend industry events to network with brokers and vendors in a manner that portrays Portage Mutual Insurance in a positive light.