Opportunity to work with a growing InsureTech whose goal is to educate customers on having safer roads and homes. Looking for Senior Accident Benefits Adjusters to join this growing team.
Title: Senior Accident Benefits Adjuster
Location: Downtown Toronto / Work from home option
- Investigate, appraise/scope, confirm coverage, negotiate settlement and recovery, and conduct reporting and documentation of claims of larger size and/or moderate complexity in accordance with established guidelines.
- Conduct investigations of claims through contact with insurers, claimants, witnesses, other carriers, physicians, contractors, lawyers, etc.
- Identify and refer to more senior staff any cases beyond limits of personal authority, expertise, and functional jurisdiction.
- Evaluate, analyze and interpret policy wordings to determine coverage applicable to the loss.
- Based on established performance and guidelines, select, assign, and proactively manage service suppliers in the resolution of the claim with a view to controlling expenses while accurately assessing policyholder indemnity entitlement.
- Create and implement an action plan for the resolution for each file.
- Proactively manage all claims to conclusion through the use and ongoing maintenance of an effective diary (i.e., follow up) system
- Ensure all incoming documentation (i.e., mail, e-mail, etc.) is responded to promptly and within company timelines
- Ensure all phone messages are responded to promptly and within company timelines
- Coordinate medical, income, and other necessary assessments and reviews.
- Determine and obtain the type of required documentation necessary to support claims in accordance with company policy, as well as federal, provincial, and local regulations.
- Review and interpret available coverage, recognizing policy exclusions, and applying facts of loss.
- Post necessary statistical data as required.
- Prepare reports for internal and external parties.
2. Ensure the accurate and efficient payment of claims.
- Review available information and establish, maintain, and recommend appropriate reserve, payment or recovery, negotiation, or declination.
- Enter and record claims, reserves, and payments.
- Process all payments promptly within guidelines and policy/statutory requirements.
- Approve reserve and payment authority requests as required.
- Prepare summaries and files for litigation, mediation/arbitration, and multidisciplinary assessments.
- Establish and monitor litigation disposition plans.
- Direct activities of defence counsel to ensure an appropriate resolution.
- Attend and participate in meetings, mediations, arbitrations, settlement conferences, pre-trials/trials.
- Participate in case law reviews.
- Adhere to service standards by communicating effectively with all parties involved.
- Provide initial contact with customers within prescribed timelines.
- Provide ongoing status updates to customers until file closure.
- Develop and maintain excellent customer relationships through face-to-face visitations, e-mail, and telephone interactions.
- Foster productive business relationships with the broker, Insured, service providers and other carriers.
- Keep insured/claimant/broker fully informed of the status of the claim.
- Develop relationships with other departments such as underwriting to meet business goals.
- Assist Manager with preparing/completing monthly statistical reports.
- Understand and apply best business practices towards compliance, internal control, and operational risk controls in accordance with national standards and regulatory standards and policies.
- Participate in monthly claims audits.
- Work collaboratively with Supervisors and/or Managers on special projects and assignments when required
- Post-secondary education and / or equivalent on the job experience
- Minimum 5-7 years Claims adjusting experience examining complex claims.
- Working knowledge of the company principles and practices related to claims settlement, policy wordings,
- insurance contracts, fraud investigations, serious losses, and coverage questions.
- Ability to work within and adapt to PC oriented environments, including familiarity with e-mail and Internet
- Working knowledge of Microsoft Office.
- Actively pursuing CIP/FCIP designation an asset.
DGA Careers has been proudly serving the Canadian insurance industry for over 30 years, specializing in providing insurance recruiting services to major insurers, insurance brokerage firms and independent adjusting firms. With offices in Toronto, Vancouver, Montreal, Edmonton, and Calgary, DGA Careers is well positioned to conduct searches with a national scope. Our unrivalled professional network across Canada provides us with the ability to reach vital key influencers and passive candidates nationally.
Interested candidates please contact Maurice Reichberg at 416-868-6711 x.232 or forward your resume in confidence to firstname.lastname@example.org. If you are working with another DGA recruiter, feel free to ask them about this position.