Claims Adjuster, Accident Benefits

Gore Mutual Insurance; Cambridge; Hybrid; CAD 55,000 - 75,000; Full time

Job summary

Gore Mutual Insurance is seeking an Accident Benefits Claims Adjuster based in Cambridge, Ontario. In this hybrid role, you will assess claims, ensure compliance, and provide exceptional support to clients. Join our team and contribute to our commitment to transparency and customer service excellence.

Qualifications

• Minimum 1-3 years of Accident Benefits claims adjusting experience.
• Proficient use of Microsoft Office applications.
• Excellent customer service, analytical, and negotiation skills.

Responsibilities

• Investigate, evaluate, and settle Accident Benefits claims with low to moderate complexity.
• Communicate with internal and external stakeholders including legal counsel and case managers.
• Proactively manage your desk by adhering to deadlines and maintaining timely reserves.

Skills

Customer service

Problem solving

Negotiation

Analytical skills

Detail-oriented

Organizational skills

Tools

Microsoft Office

Job description

Next Horizon is here. Fueled by investments in talent and technology, our bold strategy to transform is nearly complete.

At Gore Mutual, we’ve always set ourselves apart as a modern mutual that does good. Now, we’re proudly building on that legacy to transform our company—and our industry—for the better.

Our path forward sharpens our focus on business performance, driven by leading technology, innovation and an agile, high-performing culture. With Gore Mutual and Beneva announcing their intent to merge in 2026, we’ll be uniting two well-established, financially strong, and trusted brands to become the strongest mutual insurer in Canada, ensuring Canadians have purpose-driven insurance options for generations to come. Come join us.

An Accident Benefits (AB) Claims Adjuster is responsible for evaluating the validity of claims and guiding claimants through the insurance process. They assess the extent of coverage under the policy, ensuring all necessary documentation is completed and submitted. Acting as the main point of contact, you will address any questions or concerns from claimants, provide clear explanations of coverages, deductibles, and the steps involved in the claims process. Claims Adjusters process claims promptly and fairly, adhering to legal and regulatory requirements set by the Financial Services Regulatory Authority of Ontario (FSRA). They are expected to act in good faith, avoiding unreasonable denial of benefits and ensuring compliance with all relevant laws and regulations. Their role is crucial in maintaining trust and transparency between our insurance company and the claimant.

The Claims Adjuster, Accident Benefits is responsible for investigating, evaluating, reserving, negotiating, medically managing and settling claims that belong to the minor injury guidelines. They provide customer service and support our insureds with Accident Benefits claims of low to moderate complexity and value. Come join an impactful team!

What will you do?

• Investigate, evaluate, and settle Accident Benefits claims with low to moderate complexity.
• Proactively manage your desk by adhering to deadlines, keeping clear notes, and maintaining timely and accurate reserves.
• Prepare large files for discussion and review with our claims leadership team when settling and amending reserves.
• Assist the accident benefits team with overflow calls to strengthen customer service.
• Communicate with internal and external stakeholders including legal counsel, case managers, and outside vendors.
• Perform invoicing and other administrative tasks as assigned.

What will you need to succeed?

• Proficient use of Microsoft Office applications
• Minimum 1-3 years of Accident Benefits claims adjusting experience
• Proven problem solver with dispute resolution experience
• Excellent customer service, analytical and negotiation skills
• Detail oriented, highly organized, and ability to prioritize
• Team oriented, value teamwork and provide mentoring

Hybrid: We are a hybrid company and work 2 days per week in-office. This role reports to our head office in Cambridge, Ontario.

#LI-HYB & #INDHP

Gore Mutual Insurance is committed to providing accommodations for people with disabilities during all phases of the recruiting process, including the application process. If you require accommodation because of a disability, we will work with you to meet your needs. If you are selected for an interview and require accommodation, please advise the HR representative who will consult with you to determine an appropriate accommodation.

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