Creditor Claims Technical Specialist

CUMIS Services Incorporated; Burlington; Hybrid; CAD 73,000 - 121,000; Full time

Benefits offered by this job

Flexible work options

Paid time off

Health and wellness benefits

Volunteer days

Job summary

CUMIS is seeking an experienced Claims Specialist to develop and implement adjudication rules for creditor insurance claims within our risk and underwriting teams.

You will provide technical input on system rules, conduct QA audits, analyze metrics, and ensure compliance with industry standards. This hybrid role requires 6–9 years of claims experience, strong communication, and the ability to balance multiple audits and projects.

Qualifications

• 6-9 years of claims experience.
• Excellent communication skills with clear recommendations.
• Highly developed analytical mindset for reports and metrics.
• Track record of meeting deadlines and prioritizing workload.
• Expert knowledge in Claims and risk management.

Responsibilities

• Develop adjudication rules to support new products/claims while balancing risk.
• Provide claims expertise to projects and initiatives affecting claims.
• Offer technical input on changes to system business rules and auto adjudication.
• Use insights from claims data to update rules and processes.
• Follow audit best practices and conduct reviews on claim files.
• Conduct target audits on processes and systems.
• Assist with developing creditor claim standards.
• Monitor industry metrics and recommend improvements.

Skills

Claims experience

Analytical mindset

Communication skills

Deadline-driven

Job description

Company: CUMIS
Department: Cred Ins/CU Distrib
Employment Type: Regular Full-Time
Work Model: Hybrid (2 days in office)
Language: English is required, French is an asset.
Additional Information: This/these role(s) is/are currently vacant

The Opportunity:

We are a leading Canadian financial services co-operative committed to being a catalyst for a sustainable and resilient society and our team is essential to deliver on this strategy. That’s why we prioritize our people, to ensure we provide a strong culture and development opportunities which enables our team to thrive and to live our purpose. The best part is that you will work with people that care passionately about you, our clients and our communities.

Our national Creditor team aspires to develop and deliver market leading products and solutions to exceed client expectations. We think strategically and collaboratively to create mutually beneficial results and achieve business objectives. We operate with high-integrity, motivated by our desire to do the right thing for our clients and their members.

Responsible for the development, implementation and testing of business rules for the Claims System. Subject matter expert on risk assessment providing support to product, underwriting and claim staff. Conduct targeted quality assurance audits on processes, system and business rules. Responsible for process development with risk assessment, product parameters, system created business rules and client satisfaction as the focus.

How you will create impact:

• Apply risk management expertise to develop adjudication rules to support new products/benefits and new or existing claims adjudication guidelines. Includes processes to streamline claims adjudication, inclusive of auto adjudication and claim requirements, while carefully balancing acceptable risk. Adapt expertise to assessment of risk and simplify adjudication practices in an increasing digital world.
• Provide claims expertise to project/initiatives that will affect claims.
• Provide technical expertise into any proposed changes to system business rules, auto adjudication rules and claim requirements.
• Using insights developed from previous claims and underwriting experiences, make recommendations and updates to claim rules, claim requirements and processes.
• Follow audit best practice and principles. Conduct audit reviews on claim files including auto adjudicated files. Provide recommendations on findings.
• Conduct target audits on processes and systems.
• Assist with developing Claim standards applicable for creditor business.
• Monitor industry metrics and make recommendations (cycle time, decline rate)

To join our team:

• You have 6-9 years of claims experience.
• You have possess excellent communication skills, required to document processes for clear understanding, provide clear recommendations for system rules and parameters, provide recommendations to product and pricing for product development and to provide clear expectations of Claims Examiners with audit recommendations.
• You have possess a highly developed analytical mindset as they will be reviewing reports, analytics, industry metrics, claims experience in order to provide recommendations and feedback to ensure claims is competitive, cost effective and compliant with industry regulations.
• You have a track record of meeting deadlines and prioritizing workload as they will be balancing a variety of tasks.
• You have expert knowledge in Claims. This person will be responsible for applying risk management expertise to develop business rules, processes and requirements for incoming creditor insurance claims. These are critical in ensuring acceptable claim risk by the system and by Claims Examiners.
• You have conceptualized and communicate creative solutions to problems, by researching and investigating the situation using multiple information resources (ie: other departments, staff, research material, industry relationships, internet etc.)

How you will succeed:

• You have an innovative mindset to improve operational efficiencies and ability to influence change, with a primary focus on client needs.
• You use critical thinking skills to recognize assumptions, evaluate arguments, draw conclusions and proactively propose solutions.
• You have strong communication skills to clearly convey messages and explore diverse points of view.
• You build trusting relationships and provide guidance to support the development of colleagues.

What you need to know:

• You will be subject to a Background check as a condition of employment, in the event you are the successful candidate.

What’s in it for you?

• Training and development opportunities to grow your career.
• Flexible work options and paid time off to support your personal and family needs.
• A holistic approach to your well-being, with physical and mental health programs and a supportive workplace culture.
• Paid volunteer days to give back to your community.
• In addition to our competitive salary and incentive programs, eligible employees also benefit from a comprehensive total rewards package including group retirement savings plans, pension and benefits (e.g., health and wellness, dental, disability and life coverage), mental health support and an employee assistance program.

Expected salary range $72,847 - $121,411

The salary amount for the successful candidate is determined by Co-operators in its discretion and will vary depending on several criteria including but not limited to: local market conditions, geography and relevant job-related factors such as knowledge, skills, qualification, experience and education.

Employees may also have the opportunity to participate in incentive programs and earn additional compensation tied to individual and/or business performance, or other business metrics.