Senior Claims Advisor- Accident Benefits

Gore Mutual Insurance•Cambridge, ON

4d•CA$56,000 - CA$103,500•Hybrid

About The Position

An Accident Benefits (AB) adjuster is responsible for evaluating the validity of claims and guiding claimants through the insurance process. They assess the extent of coverage under the policy, ensuring all necessary documentation is completed and submitted. Acting as the main point of contact, they address any questions or concerns from claimants, providing clear explanations of coverages, deductibles, and the steps involved in the claims process. They process claims promptly and fairly, adhering to legal and regulatory requirements set by the Financial Services Regulatory Authority of Ontario (FSRA). They are expected to act in good faith, avoiding unreasonable denial of benefits and ensuring compliance with all relevant laws and regulations. The AB Senior role is responsible for investigating, evaluating, reserving, negotiating, medically managing and settling MIG and Non-Catastrophic AB claims of moderate complexity and value (IRB, Non-Earner/Priority loss transfers within authority). They also serve as formal and informal mentors to our Med Desk adjusting Team.

Requirements

Post Secondary Education: Typically a relevant degree/diploma in insurance or a related field.
5 years of AB Claims Handling experience strongly preferred
Exposure to LAT Handling process.
Capable dispute resolution.
Some litigation management for AB.
Experience attending and achieving desirable file resolutions through Settlement Conferences.
Effective Communication.
Critical Judgement and Decision Making.
Resilience.
Attention to Detail.
Claims Negotiation and Settlement.
Assessment and interpretation of medical reports and injuries.
Claims Evaluation and Investigation.
Dispute and Litigation Management for AB Ontario.
Advanced understanding of SABS.
Mentoring.

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 moderate complexity.
This occasionally includes preparing and presenting files for authority or strategic approval as well as attending hearings or case conferences.
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.
Coaching and mentoring Med Desk Team.
Invoicing and administrative tasks.