Int Representative, Claims- Ontario
About The Position
Reporting to the Team Leader, Accident Benefit Claims, you are accountable for investigating, evaluating and settling Accident Benefit claims. This role involves securing details of claims by corresponding with claimants and/or representatives, assessing coverage eligibility, and applying interpretations of policy wordings. You will also apply the applicable Priority Rules chart, process various types of claims (income replacement, non-earner, attendant care), and appropriately reserve files after assessing them. Maintaining detailed electronic records, processing payments, coordinating claim actions, confirming collateral benefits, and responding to claimant correspondence are key aspects of this position. Additionally, you will review and approve treatment plans, arrange insurer examinations, prepare referral packages, obtain medical information, and respond to assessment recommendations. Other duties as assigned.
Requirements
- University degree, college diploma in related field or the CIP designation
- Minimum 2-3 years of claims handling experience
- Proficient in MS Word and Excel
- Professional, friendly and courteous in all interactions, whether with customers or co-workers
- Able to perform well in a busy operation and remain calm under pressure
- Team player adaptable to a changing environment
- Strong written and verbal communication skills
- Successful clearance of background checks (including criminal checks and leadership references)
Nice To Haves
- Interested in this role, but don’t meet every requirement? We encourage you to apply! We know from experience that a candidate doesn’t need 100% of the qualifications listed to bring incredible value to our team. We’re actively seeking diverse backgrounds and perspectives to help us make insurance better. At Definity, inclusion, diversity, and equity aren’t just “nice to have” — they’re essential to our success.
Responsibilities
- Investigating, evaluating and settling accident benefit claims in accordance with the Insurance Act
- Securing details of claims by corresponding with claimants and/or representatives
- Assessing coverage eligibility and reviewing and applying interpretations of policy wordings in the resolution of coverage issues
- Applying applicable Priority Rules chart to each claim file
- Processing income replacement, non-earner, and attendant care claims
- Reserving files appropriately after assessing claim
- Maintaining detailed file records on an electronic claims system
- Processing payments after confirming benefits, eligibility and reserves
- Coordinating the most effective course of action for claims
- Confirming collateral benefits
- Responding to claimant correspondence and accident benefit forms in accordance with the applicable legislation
- Reviewing and approving, when appropriate, treatment plans for claimant rehabilitation
- Arranging insurer examinations to determine benefits eligibility
- Preparing referral packages and obtaining the necessary medical information for insurer examinations
- Responding to assessment recommendations
- Other duties as assigned
Benefits
- Hybrid work schedule for most roles
- Company share ownership program
- Incentive Program - Eligible employees may participate in various incentive plans which are paid out at the discretion of the company and subject to individual and company performance.
- Pension and savings programs, with company-matched RRSP contributions
- Paid volunteer days and company matching on charitable donations
- Educational resources, tuition assistance, and paid time off to study for exams
- Focus on inclusion with employee groups, support for gender affirmation surgery, access to BIPOC counsellors, access to programs for working parents
- Wellness and recognition programs
- Discounts on products and services
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
