Accident Benefits Claims Representative - lI

Portage la Prairie Mutual Insurance Company; Edmonton; Hybrid; CAD 64,000 - 72,000; Full time

Benefits offered by this job

Hybrid work arrangement

Job summary

Portage Mutual Insurance in Edmonton is seeking an Accident Benefits Claims Representative II to investigate, evaluate, reserve, negotiate and resolve automobile accident benefits claims. You will review losses, gather statements, obtain medical records and apply regulatory classifications to determine eligibility.

Role requires 3–5 years in auto physical damage adjusting, proficiency with Guidewire, and strong communication skills.

Qualifications

• Minimum of 3–5 years experience with auto physical damage adjusting.
• Proficient in Microsoft Office Suite and Guidewire.
• Excellent verbal and written communication with high level of confidentiality.

Responsibilities

• Review new losses, prepare an investigation plan, and contact the insured to discuss loss details.
• Explain the claims process clearly to policyholders to ensure an efficient claims experience.
• Secure statements from policyholders and third parties as needed.
• Obtain medical authorizations and required forms.
• Arrange independent medical examinations to assess coverage and damages.
• Negotiate settlements within authority limits based on investigation results.

Skills

Auto physical damage

Microsoft Office

Guidewire

Education

Post-secondary education in business/healthcare/insurance

Insurance or medical reception background

Tools

Guidewire

Job description

About Portage Mutual: Where Your Talent Makes a Difference Imagine a workplace where your contributions are not only valued but also directly impact the lives of Canadians. At Portage Mutual Insurance, we’re more than just a trusted national property and casualty insurer—we’re a community of passionate individuals dedicated to serving our policyholders since 1884. Owned by our policyholders, we proudly offer competitive home, auto, commercial, and farm insurance products 100% through our broker network across Canada. Join a company rooted in tradition, driven by innovation, and powered by a people-first culture.

Why Portage Mutual? At Portage Mutual, we believe that our people are our greatest asset. Here, you’ll find:

• Total Rewards: We care about your well-being and financial security. That’s why we offer a competitive salary, incentive plan, comprehensive health benefits, a pension plan and generous paid time off, including personal days.
• Career Growth & Development: Propel your career forward with access to diverse learning resources, tuition reimbursement for relevant programs, and bonuses recognizing your achievements in pursuing insurance designations.
• Flexibility: We support work-life integration by offering a flexible environment where you can choose to live wherever you prefer in Canada. Enjoy the freedom to select remote, in-office, and hybrid work arrangements that best suit your lifestyle.
• Inclusivity and Belonging: Be a part of a supportive and diverse team that embraces your unique perspective and empowers you to succeed. We’re dedicated to creating a workplace where every employee feels welcomed, valued and respected.
• Making a Difference: Find purpose in your career by aligning with an organization that shares your values and is committed to making a difference in the communities we serve.

The Opportunity

Accident Benefits Claims Representative II

As an Accident Benefits Claims Representative – II, you’ll investigate, evaluate, reserve, negotiate and resolve assigned automobile accident benefits claims by: Reviewing new losses, developing investigation plans, gathering statements, obtaining necessary documentation (medical records, authorizations, forms), and applying regulatory classifications accurately. Communicating with policyholders, treatment providers, investigators, accountants, and medical professionals to assess injuries, financial losses, and determine claim eligibility. Utilizing systems like HCAI, applying dispute resolution techniques, and leveraging structured settlements and independent medical exams to ensure fair and timely claim outcomes. We’re looking for a detail-oriented, enthusiastic team player who embodies our company values and is committed to providing top-notch service.

What You’ll Do

• Review new losses, prepare an investigation plan, and contact the insured to discuss loss details.
• Work with policyholders to explain claims process in a clear and concise manner to ensure an efficient claims experience.
• Secure statements with policyholders, third parties, independent witnesses, passengers as necessary.
• Secure medical authorization, statutorily required forms, and medical opinions as necessary.
• Arrange appropriate independent medical examinations to aid in the assessment of coverage, injuries and damages.
• Assess the need and retain licensed investigators to assist in understanding injury severity.
• Work with accountants to assess income and other financial losses related to accident benefit coverages.
• Review complex policy wordings and legislation to assess coverage eligibility.
• Communicate verbally and in writing to policyholders and brokers coverage positions.
• Review complex medical forms and reports to determine benefit payment eligibility.
• Negotiate settlements based on results of loss investigation, coverage analysis and damage assessment within authority limits.
• Complete ongoing follow up communication per corporate service standards with all file stakeholders to bring claim to resolution.
• Attend industry events to network with brokers and vendors in a manner that portrays Portage Mutual Insurance in a positive light.

What You’ll Bring

• Minimum of 3-5 years experience with auto physical damage adjusting, in a medical professional office, and in a role dealing with accident benefit claims.
• Proficient in Microsoft Office Suite and relevant claims systems (e.g., Guidewire), with the ability to adapt to new technologies.
• Consistently applies accuracy, thoroughness, and meticulousness in all aspects of work.
• Strong critical thinking and problem-solving skills to assess the strengths and weaknesses of each claim within authority limits.
• Excellent verbal and written communication skills.
• High level of confidentiality.
• Ability to work independently or as a collaborative team and is self-motivated to work in a fast-paced changing environment.
• Post-secondary education in business, nursing, health care aid, insurance or medical reception.
• CIP designation completed, actively in progress, or willing to work towards.

Job Title: Accident Benefits Claims Representative II

Reports To: Director Automobile Claims

Location: Hybrid - Edmonton

Salary Range: $64,000 - $72,000

This role requires a hybrid work arrangement and is not intended to be fully remote. While candidates located in Edmonton, Alberta are preferred, consideration will also be given to candidates from other provinces who reside within reasonable commuting distance of the Portage la Prairie, Winnipeg, or St. Catharines offices, with required availability during Mountain Time Zone working hours.

Portage Mutual uses artificial intelligence and automations in its recruitment practices for activities that may include searching for qualified candidates, screening applications, preparing interview questions, recording interviews, drafting transcripts and other administrative tasks. AI is never used for decision making purposes.

Ready to Make an Impact?

We value diversity in backgrounds, experiences, and perspectives because the communities we serve are diverse. Rooted in a long-standing commitment to trust, community, and mutual support, Portage Mutual Insurance is proud to foster an inclusive workplace where employees are encouraged to collaborate, learn from one another, and grow together.

Accommodations are available throughout the recruitment process upon request. If you require accommodation, we will work with you to ensure a fair and positive candidate experience.

To be considered for this opportunity, candidates must have the legal right to work in Canada.

Any employment offer will be conditional upon the successful completion of applicable pre-employment screening requirements.

Life at Portage Mutual is built on connection - to our work, the communities we serve, and each other. Our people work among collaborative teams where trust, respect, and support guide how we show up every day. We value shared success, open dialogue, and looking out for one another, creating an environment where employees feel welcomed, included, and proud of the impact they make together. Here, you’re not just joining an organization; you’re becoming part of a community.