Claims Advisor- Accident Benefits

Gore Mutual Insurance•Cambridge, ON

5d•CA$52,500 - CA$86,500•Hybrid

About The Position

At Gore Mutual, we’ve always set ourselves apart as a modern mutual that does good. Now, we’re proudly building on that legacy to transform our company—and our industry—for the better. Effective January 1, 2026, Gore has joined Beneva—the country’s largest mutual insurance company—as part of its Property & Casualty operations in Ontario and Western Canada. During 2026, Gore will combine its operations with Unica Insurance, Beneva’s Ontario-based subsidiary specializing in niche commercial and personal insurance, creating a stronger, more diversified mutual insurer with greater scale and long-term stability. Every decision and investment remains anchored in long-term benefits to customers, members, and communities. Come join us. The Accident Benefits (AB) Claims Advisor investigates, evaluates, and manages low- to moderate-complexity claims—particularly those under the Minor Injury Guideline—by confirming coverage, collecting and reviewing documentation, setting reserves, negotiating and settling claims, coordinating medical management, and guiding claimants through the process with clear, timely, and good-faith communication, while also providing front-line support to vendors, clinics, and insureds and ensuring compliance with FSRA and all applicable legal and regulatory requirements.

Requirements

Post secondary Education
2 years of Claims Handling Experience
Capable problem solving and dispute resolution
Experience working by phone
Successful hybrid/work from home experience

Nice To Haves

CIP designation is an asset
Previous exposure to APD handling
Previous exposure to AB Admin role is of great value

Responsibilities

Reviewing, investigating and documenting medical reports and claim related information and the appropriate setting of AB Claims reserves.
Negotiation and Settlement of claims of low to moderate complexity. This occasionally includes preparing and presenting files for authority or strategic approval.
Supports claims through the timely review and adjudication of Medical Treatment and Assessment Plans, within authority
Direct communications with claimants/ guardians (phone or written) for medically managed claim files
Communication between internal and external legal counsel, case managers, and outside vendors
Invoicing and administrative tasks