Claims Specialist - Alternate Dispute Resolution

TD•Markham, ON

2d•CA$79,100 - CA$111,700•Onsite

About The Position

Under minimal supervision, contribute to sustained revenue growth and profitability objectives of the business by handling and proactively managing Accident Benefit claims disputes with a high level of technical expertise. Responsible for the management of Accident Benefit disputes, following established claims settlement and case reserving policies, while ensuring regulatory compliance and coverage interpretation throughout the resolution of the claim. Emphasis is placed on delivering an optimal client experience during the dispute handling of claims while ensuring fair and equitable resolutions. Provides Accident Benefit claims technical expertise coaching for colleagues within the unit, working closely with regional and national claims management teams. Emphasis is placed on working in a team environment that supports individual learning and development and the achievement of goals and objectives while creating and maintaining a positive and motivating work environment. An additional key responsibility will involve acting as a Specialist Complex Claims Advisor Accident Benefits, acting with a sense of urgency in identifying and meeting client needs. This includes ensuring timely and thorough investigation of claims involving predominantly complex issues and/or high exposures, identifying client eligibility and/or entitlement, and ensuring quick access to all available benefits in order to promote treatment and recovery, and to help the client return to optimal function. Responsible for case handling of claims involving predominantly complex issues and/or high exposures including catastrophic injuries; priority of payment, loss transfer and loss reserving. Some participation may be required in large loss meetings, mediations, arbitrations and litigations. Ensure accurate and timely reserves and take a total cost management approach to claims. Record and verify information and documentation from all available sources to ensure a thorough and complete compilation of facts required to resolve the claim; and identify potential coverage issues and/or recovery/liability opportunities. Using established protocols, analyze and evaluate facts of an individual case to assess the benefits available to the client. Make good decisions based upon a mixture of analysis, wisdom, experience, and judgment. Read and remain current and up to date on case law, legal changes and recent settlements which affect accident benefit claims. Apply departmental protocols to ensure efficient, productive and cost-effective results. Meet productivity objectives set by the department in terms of pending file count and open/close ratio.

Requirements

Post-secondary education
5-7 years relevant and progressively more responsible Accident Benefit claims work experience, case managing complex Accident Benefit claims with your exceptional technical skills.
Advanced knowledge of principles and methods pertaining to the resolution of claims
Knowledge of claims management practices, company operations and policies
Strong relationship builder
A proven collaborative approach to problem solving, decision-making and communication with a broad range of audiences
Effective communication skills including facilitation, consultation, negotiation, and persuasion
Demonstrated ability to collaborate, coach, counsel and train Advisors
Strong team player, works well under pressure and ability to deal effectively with change
Superior organizational and time management skills
Ability to identify significant business risks/opportunities and controls/enabler

Nice To Haves

Advanced insurance-related designations (CIP/FCIP) would be an asset

Responsibilities

Handle and proactively manage with a high level of technical expertise disputes that arise from Accident Benefit claims.
Responsible for the management of Accident Benefit disputes, following established claims settlement and case reserving policies, while ensuring regulatory compliance and coverage interpretation throughout the resolution of the claim.
Deliver an optimal client experience during the dispute handling of claims while ensuring fair equitable resolutions to all claims.
Provides Accident Benefit claims technical expertise coaching for colleagues within the unit working closely with the regional and national claims management teams.
Act as a Specialist Complex Claims Advisor Accident Benefits, act with a sense of urgency in identifying and meeting client needs.
Ensure timely & thorough investigation of claims involving predominantly complex issues and/or high exposures, identifying client eligibility and/or entitlement, and ensuring quick access to all available benefits in order to promote treatment and recovery, and to help the client return to optimal function.
Responsible for case handling of claims involving predominantly complex issues and/or high exposures including catastrophic injuries; priority of payment, loss transfer and loss reserving.
Participate in large loss meetings, mediations, arbitrations and litigations.
Ensure accurate and timely reserves and take a total cost management approach to claims.
Record and verify information and documentation from all available sources to ensure a thorough and complete compilation of facts required to resolve the claim; and identify potential coverage issues and/or recovery/liability opportunities.
Analyze and evaluate facts of an individual case to assess the benefits available to the client.
Make good decisions based upon a mixture of analysis, wisdom, experience, and judgement.
Read and remain current and up to date on case law, legal changes and recent settlements which affect accident benefit claims.
Apply departmental protocols to ensure efficient, productive and cost-effective results.
Meet productivity objectives set by the department in terms of pending file count and open/close ratio.