Adjuster Level II, Accident Benefits Claims

Heartland Mutual Insurance Company; Kitchener; On-site; CAD 62,000 - 93,000; Full time

Job summary

Heartland Mutual Insurance Company is seeking an Adjuster Level II, Accident Benefits Claims in Waterloo, Ontario. The role manages a range of injury claims under the SABS, with emphasis on MIG claims and non-complex disputes, while supporting fraud investigations and stretch development toward Level III.

Qualifications include 2-4 years of accident benefits adjusting, CIP in progress preferred, and strong knowledge of SABS and medical provider protocols.

Qualifications

• 2-4 years of Accident Benefits adjusting experience.
• Post-secondary education in Insurance, Business, or a related field; CIP designation in progress preferred.

Responsibilities

• Independently manage MIG claims, including those with specified benefits such as income replacement, medical, and rehabilitation benefits.
• Handle non-complex priority disputes, providing clear documentation and supporting analysis.
• Ensure timely adjudication of benefits, reserving accuracy, and compliance with SABS timelines.
• Maintain professional and empathetic communication with claimants, medical providers, legal representatives, and internal partners.
• Coordinate assessments, monitor treatment plans, and follow up on insurer examinations and independent evaluations.
• Maintain thorough, accurate file notes and documentation in accordance with regulatory and organizational standards.
• Identify potential indicators of fraud and work collaboratively with the Senior Special Investigator as required.
• Escalate files with complexity beyond scope or where annuity settlements or catastrophic impairment assessments are involved.
• Support junior team members and coordinate with Appraisers, Legal Counsel, and Medical Consultants.
• Communicate effectively with Brokers, Agents, and Direct Sales Center staff to ensure seamless claims experience.
• Handle 5-10% of stretch files to support development toward Level III responsibilities.
• Participate in training sessions, feedback loops, and quality assurance reviews.
• Adhere to all applicable legislation, including SABS and privacy requirements.
• Complete Priority and Loss Transfer Reviews in accordance with department expectations.
• Contribute process feedback to help improve operational effectiveness and customer outcomes.

Skills

Analytical thinking

Decision making

Interpersonal skills

Time management

Education

CIP designation in progress

Tools

Claims systems

Regulatory databases

Job description

Adjuster Level II, Accident Benefits Claims - Waterloo, Ontario

The Adjuster Level II, Accident Benefits Claims, is responsible for managing a range of injury claims under the Statutory Accident Benefits Schedule (SABS) with moderate complexity. This includes handling Minor Injury Guideline (MIG) claims with and without specified benefits and certain non-complex priority disputes. The role supports the development of strong technical skills while also contributing to early investigations of potential fraud and identifying opportunities for priority and loss transfer reviews. This role is designed to bridge foundational and advanced claims handling, offering stretch development files (5-10%) to prepare for Level III responsibilities.

What you will do...

Injury Claims Handling:

• Independently manage MIG claims, including those with specified benefits such as income replacement, medical, and rehabilitation benefits.
• Handle non-complex priority disputes, providing clear documentation and supporting analysis.
• Ensure timely adjudication of benefits, reserving accuracy, and compliance with SABS timelines.

Stakeholder Communication and File Management:

• Maintain professional and empathetic communication with claimants, medical providers, legal representatives, and internal partners.
• Coordinate assessments, monitor treatment plans, and follow up on insurer examinations and independent evaluations.
• Maintain thorough, accurate file notes and documentation in accordance with regulatory and organizational standards.

Risk Assessment and Escalation:

• Identify potential indicators of fraud and work collaboratively with the Senior Special Investigator as required.
• Escalate files with complexity beyond scope or where annuity settlements or catastrophic impairment assessments are involved.

Interdepartmental and External Collaboration:

• Support junior team members and coordinate with Appraisers, Legal Counsel, and Medical Consultants.
• Communicate effectively with Brokers, Agents, and Direct Sales Center staff to ensure seamless claims experience.

Development and Stretch Assignments:

• Handle 5-10% of stretch files to support development toward Level III responsibilities.
• Participate in training sessions, feedback loops, and quality assurance reviews.

Regulatory Compliance and Technical Contribution:

• Adhere to all applicable legislation, including SABS and privacy requirements.
• Complete Priority and Loss Transfer Reviews in accordance with department expectations.
• Contribute process feedback to help improve operational effectiveness and customer outcomes.

What you will bring...

Education & Experience:

• 2-4 years of Accident Benefits adjusting experience.
• Post-secondary education in Insurance, Business, or a related field; CIP designation in progress preferred.

Technical Skills & Knowledge:

• Proficient understanding of the SABS framework, injury claim management, and specified benefits.
• Familiarity with claims systems, insurer assessments, and medical provider protocols.

Competencies:

• Analytical thinking and confident decision-making.
• Excellent interpersonal, organizational, and time management skills.
• Professionalism, discretion, and ability to manage sensitive, confidential information.
• A strong commitment to continuous learning, collaboration, and customer service excellence.

The salary range for this role is $62,000 - $93,000. The salary for the successful candidate will be determined by various factors including but not limited to an individual’s relevant experience, knowledge, skills, along with internal equity, and market considerations.