Catastrophic Claims Advisor

The Personal Insurance Company; Burlington; On-site; CAD 90,000 - 120,000; Full time

Benefits offered by this job

Competitive salary

Annual bonus

Vacation: 4 weeks

Pension plan

Group insurance including telemedicine

Telework equipment

Job summary

Desjardins seeks a Catastrophic Claims Advisor in Ontario to guide clients through complex accident benefits claims, coordinating with healthcare providers, legal representatives, and rehabilitation specialists. The role emphasizes empathy, advocacy, and a client-centered approach to functional recovery.

You will investigate high-complexity claims, maintain clear client communications, and collaborate with internal and external counsel to resolve LAT disputes, reconsiderations, and hearings,

Qualifications

• Bachelor's degree in a related field is required.
• Minimum of five years of relevant accident benefits claim handling experience.
• CIP designation or enrollment in the program.

Responsibilities

• Investigate, evaluate and negotiate high-complexity accident benefit claims, ensuring compliance with regulatory and contractual obligations and DGIG best practices.
• Maintain clear and timely communication with clients, providing updates and guiding them through the claims process.
• Manage Catastrophic claims with a focus on functional recovery and fair outcomes.

Skills

Client communication

Edging on English proficiency

Advocacy

Education

Bachelor's degree

CIP designation

Job description

We are seeking highly skilled and empathetic Ontario Accident Benefits Claims professional, looking for an opportunity to make a meaningful impact on the lives of our clients while working in a dynamic, supportive, and collaborative environment. The Catastrophic Claims Advisor serves as a trusted guide and advocate for clients navigating complex catastrophic claims. Partnering with healthcare providers, legal representatives, rehabilitation specialists, and other key stakeholders, the advisor provides guidance, advocacy, and coordination throughout the claims process. Combining technical expertise with professionalism, empathy, and compassion, the role focuses on supporting each client's functional recovery, and ensuring their unique needs are met through a personalized, client-centered approach. You will be a key contributor to our mission of delivering exceptional claims service and client care.

Responsibilities

• Investigate, evaluate and negotiate accident benefit claims of high complexity, ensuring compliance with regulatory and contractual obligations, as well as DGIG best practices
• Maintain clear and timely communication with clients, providing updates on the status of their claims, addressing inquiries and guiding them through the claims process
• Manage Catastrophic claims with a keen focus on functional recovery
• Identify and resolve challenges, including complex or sensitive issues, with a focus on achieving fair outcomes and supporting client well-being
• Conduct settlement discussions and negotiate resolutions where appropriate
• Collaborate with internal and external legal counsel on LAT disputes, reconsiderations, judicial reviews, mediations, and hearings
• Collaborate effectively with internal and external stakeholders - such as medical professionals, legal representatives, and rehabilitation providers - to support client recovery and claim resolution
• Apply accurate reserving practices and ensure timely issuance of claim payments in accordance with company standards and best practices.

What we offer

• Competitive salary and annual bonus
• 4 weeks of flexible vacation starting in the first year
• Defined benefit pension plan that provides predictable, stable income throughout retirement
• Group insurance including telemedicine
• Reimbursement of health and wellness expenses and telework equipment
• Benefits apply based on eligibility criteria.
• #LI-Hybrid, #ON09

What you bring to the table

• Bachelor's degree in a related field
• A minimum of five years of relevant experience in accident benefits claim handling
• Please note that other combinations of qualifications and relevant experience may be considered Advanced experience managing medical and disability files within the constraints of the Statutory Accident benefits schedule with a focus on functional recovery
• CIP designation or enrolled in the program
• Advanced proficiency of English due to the nature of the duties or work tools or because the position involves interactions with English-speaking partners, members and/or clients
• Advanced knowledge of regulatory and contractual obligations (Statutory Accident Benefits Schedule)
• Advanced knowledge of medical and legal terminology, vocational rehabilitation concepts and disability management principles
• Action oriented
• Business insight
• Complexity
• Customer Focus
• Decision quality
• Differences
• Interpersonal Savvy
• Nimble learning
• Equity, Diversity, Inclusion and Accessibility

At Desjardins, we believe in equity, diversity and inclusion. We're committed to welcoming, respecting and valuing people for who they are as individuals, learning from their differences, embracing their uniqueness, and providing a positive workplace for all. At Desjardins, we have zero tolerance for discrimination of any kind. We believe our teams should reflect the diversity of the members, clients and communities we serve. If there's something we can do to help make the recruitment process or the job you're applying for more accessible, let us know. We can provide accommodations at any stage in the recruitment process. Just ask!

Trade Union (If applicable)

Job Family Member/client sales and service (FG)

Desjardins Group is the largest cooperative financial group in North America. We're the choice for over 52,000 employees and we're named one of Canada's top employers by Mediacorp and Forbes. We offer a full range of financial products and services and share our expertise in personal services, business services, wealth management, life and health insurance, and property and casualty insurance. Pursuing a career at Desjardins means being part of an organization that puts people first.