Account Manager, Claims

Next Insurance, Inc.; Toronto; Hybrid; CAD 113,000 - 130,000; Full time

Benefits offered by this job

Hybrid work environment

Annual company bonus

Health and dental benefits

LinkedIn Learning access

Education assistance

Job summary

Munich Re in Toronto is seeking an experienced claims professional to adjudicate and manage complex disability, life, and long-term care claims. You will apply internal standards, identify coverage issues, and coordinate with clients and internal partners to drive timely, accurate payments.

The role emphasizes client communication, data analysis, and participation in audits, with hybrid work and opportunities to mentor others.

Qualifications

• Bilingual English/French required with strong verbal and written skills.
• Minimum 3+ years in insurance claims handling.
• Experience in disability, life or long-term care claims preferred.
• University degree with insurance designations preferred.

Responsibilities

• Adjudicate claims within internal quality standards and delegated authority.
• Identify coverage and payment discrepancies and resolve them.
• Provide data-driven insights through claim analytics and trend analysis.
• Maintain meticulous claim documentation and follow-up actions.
• Mentor internal team members on complex claim investigations.
• Present findings and recommendations to management and clients.

Skills

Bilingual English/French

Strong analytical skills

Excellent communication skills

Client relationship management

Data mining and trend analysis

Education

University degree with LOMA/ICA or other insurance designations

Tools

Power BI

Job description

Position Overview

• Expertly adjudicate assigned claims, communicate critical issues and claim handling requirements clearly. and professionally to clients and capture data effectively and efficiently.
• Evaluate and proactively support clients in enhancing claim practices via training or one-on-one discussions.
• Contribute to internal claims department initiatives and selected internal projects.
• Share business-critical knowledge across team and organization.

Your role:

Claim Adjudication

• Conduct expert individual claim adjudication within internal quality standards, delegated authority limits and client response timelines.
• Identify coverage and payment discrepancies, address and resolve coverage anomalies.
• Proactively identify, assess, manage and resolve claim evidence inconsistencies with clients.
• Promptly approve payments in accordance with payment authorization protocols and client service level agreements.
• Archive all claim documentation in an appropriate and orderly manner, perform required claim file follow ups.
• Utilize data management and claim system software and tools effectively to adjudicate and monitor claim risks.

Client Management

• Establish strongly positive, beneficial, long-term client relationships through professional, timely and knowledgeable communication.
• Monitor client claim results and provide accurate client information on a timely basis to Management through claim analytics, data mining and trend analysis.
• Assist with identifying/implementing initiatives to enhance claim handling efficiencies and effectiveness.
• Develop and implement strategies to track and improve claim results or client expertise.

Risk Monitoring and Claim Audits

• Validate treaty compliance during client claim audits, communicate findings to internal business partners, and provide best practice recommendations for action/resolution.
• Produce excellent written analytical client audit reports with sound recommendations within expected timeframes.
• Follow up on recommended client actions to improve client review results.
• Present claims to Senior Management for evaluation/authority including completion of pertinent claim summary reports and notice of high exposure claims.

Knowledge Transfer

• Provide technical mentoring on complex claims to clients or internal Claims team members.
• Develop and deliver leading-edge knowledge of insurance claim investigations and practices through presentations, surveys and publications.
• Engage with pricing, underwriting, and legal to ensure treaty and contractual liabilities, product language and client decisions meet Munich Re’s risk standards and intent.
• Apply expert risk management knowledge/analysis to claim scenarios and share expertise throughout the organization.

Your Profile:

• Minimum 3+ years in insurance claims, with primary expertise in Individual or Group Disability claims, as well as Long Term Care, Critical Illness as well as Life claims. Reinsurance experience is an asset.
• Bilingual in English/French, with demonstrated verbal and written proficiency required.
• Demonstrated ability to build solid client relationships. Experience in customer service/call centre is an considered an asset.
• University degree in combination with LOMA, ICA or other insurance designations.
• Requirement to work in Toronto office under hybrid work model
• Demonstrated thoroughness, accuracy and attention to detail in claim reviews and data capture.
• Strong analytical and inquisitive skills.
• Excellent attention to meeting time service and achieving deliverables.
• High degree of self-motivation, continuing development and proven ability to work independently.
• Demonstrated desire and aptitude to learn multiple lines of business and claim types.
• Excellent presentation and report creation and delivery skills, strong verbal and written communication skills.
• Knowledge of Underwriting concepts and medical terminology is an asset.
• Power BI and related coding skills is an asset.
• Limited travel within Canada is expected.

About Munich Re

Together, we engage with everything we have and are, to help humankind act braver and better.

As the world’s leading reinsurance company with more than 40,000 employees in over 50 locations around the globe, Munich Re introduces a paradigm shift in the way you think about insurance. By turning uncertainty into manageable risk, we enable fundamental change. We recognize Diversity, Inclusion, and Belonging as a key priority with a culture that welcomes different thoughts and opinions. We dare to think big and are continuously innovating on behalf of our clients.

Our data, our technology, and our teams place us in a unique position to drive transformative change in the life insurance industry. We invest strategically in our world class talent, offering our employees a work experience that promotes professional development, innovation, and rewards high performance.

What Can We Offer You?

We are pleased to offer our employees great benefits and resources to support their mental, physical and financial wellbeing. These include:

• An engaging and collaborative environment that promotes continuous learning and development
• A hybrid work environment that combines weekly in-office and remote days
• A great compensation package including annual company bonus
• Market leading company-paid flexible health and dental benefits, starting on your first day
• Flexible dollars provided by the company to put towards Health Spending Account and/or Wellness Spending Account
• Immediate participation in DC Pension Plan with an automatic employer contribution, plus optional company match
• Generous time off including vacation, personal days, unplanned time, Statutory Holidays and company-wide early closure half-days
• Learning and development programs and resources, including unlimited access to LinkedIn Learning, Education Assistance Program and reimbursement for professional fees
• Maternity, Parental & Adoption Leave top-up program
• Employee Referral Program, Recognition & Rewards Platform

Our base salary range for this role is between $112,670 and $130,460 per year, plus an opportunity for an annual company bonus based upon a percentage of eligible pay. The salary estimate displayed represents the typical salary range for candidates hired in this position. Factors that may be used to determine your actual salary include your specific skills, how many years of experience you have and comparison to internal equity.

This role is located in our Toronto office on 390 Bay St, and we operate in a hybrid work model. This job posting is for an existing vacancy.

We do not use AI in our recruitment process - applications are reviewed by our team to ensure a fair and personalized experience.

Please note that only candidates who are selected for interview will be contacted directly. We thank all candidates for their interest.

Munich Re is committed to providing a work environment that is inclusive and free of employment barriers and discrimination. Accommodations will be made for qualified applicants with a disability throughout the recruitment process. If you receive a request for an interview and you have a disability which will require an accommodation to support your participation, please contact [e-mail] as soon as practical so that suitable accommodations can be arranged.