GENERAL DESCRIPTION

To support operational partners on the Accident Benefit team by providing reserve and settlement authority as well as on going technical guidance and direction to Claims Advisors (Inside and Field). To provide quality assurance services to claims operations to meet risk management, productivity and client satisfaction objectives.

Coaches Claims Advisors on developing their technical skills, and impart technical expertise. Support is for Mississauga and Branch offices.
Advise Claims Advisors on the application of various insurance contracts and verify conformance with our payment policies and the cost of settling claims.
Analyze claims and prepare appropriate directives for Advisors and other parties involved regarding the settlement of claims.
Seek settlement solutions and propose them to the Advisors, clients and other parties involved in cases that are in dispute or beyond the Advisor's authority limits. Follow up on results.
Verify and approve the settlement of claims submitted.
Audit claim files for identification of trends and to identify skill gaps.
In time of high volume, assists operations by examining overflow files.

EDUCATION & TECHNICAL COMPETENCIES

Post-secondary education (College diploma or University degree) in business or insurance related field is preferred; combination of related education and experience will be considered.
CIP designation or enrolled in the program.
6 - 7 years of claims experience with the majority in casualty claims handling, primarily in Accident Benefit Claims.
Knowledge of investigative techniques.
Sound knowledge of current laws and regulations and their application.
Good knowledge of medical terminology and ability to analyze medical reports.
An advanced level of English proficiency required.

NON-TECHNICAL COMPETENCIES

Customer Service oriented
Action and results oriented
Proven problem-solving ability
Decisive/Able to deal with ambiguity
Effective listening skills
Motivator
Time management skills

ADDITIONAL INFORMATION

Note: Candidates will be required to complete a technical competency test as part of the interview process.

We are an equal opportunity employer

REPORTS TO: Section Manager, Claims Specialists

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