Senior Claims Adjuster, Accident Benefits

Economical; Canada; Remote; CAD 60,000 - 80,000; Full time

Benefits offered by this job

Great benefits

Ongoing education

Competitive pay

Job summary

Economical in Canada is hiring for an Accident Benefits Claims professional to investigate, evaluate, and settle claims in accordance with the Insurance Act and statutory benefit schedules.

You will secure claim details, assess eligibility, apply policy interpretations, and manage complex files while maintaining detailed electronic records and coordinating medical examinations as needed.

Qualifications

• University degree in any discipline or a college diploma or the CIP designation.
• Minimum of 4 years Claims handling experience.
• Experience handling mediations.

Responsibilities

• Investigate, evaluate and settle Accident Benefit claims.
• Assess coverage eligibility and interpret policy wordings.
• Apply Priority Rules chart to each claim file.
• Process election of benefit claims and reserve appropriately.
• Maintain detailed file records on an electronic claims system.
• Coordinate examinations and obtain medical information.
• Respond to claimant correspondence andAssist in dispute resolution.

Skills

Claims handling

Mediations

MS Word

MS Excel

Written communication

Verbal communication

Team player

Calm under pressure

Education

University degree

College diploma

CIP designation

Tools

MS Word

MS Excel

Job description

ONT, Canada

The Opportunity

Reporting to the Team Leader, Accident Benefit Claims, you are accountable for investigating, evaluating and settling Accident Benefit claims in accordance with the Insurance Act and the Statutory Accident Benefits Schedule.

What to Expect

• Securing details of claims by corresponding with claimants and/or representatives
• Assessing coverage eligibility and reviewing and applying interpretations of policy wordings in the resolution of coverage issues
• Applying applicable Priority Rules chart to each claim file
• Processing election of benefit claims
• Reserving files appropriately after assessing claim
• Maintaining detailed file records on an electronic claims system
• Processing payments after confirming benefits, eligibility and reserves
• Coordinating the most effective course of action for claims
• Responding to claimant correspondence and Accident Benefit forms in accordance with the applicable legislation
• Reviewing and approving, when appropriate, treatment plans for claimant rehabilitation
• Arranging insurer examinations to determine benefits eligibility
• Preparing referral packages & obtaining the necessary medical information for insurer examinations
• Responding to assessment recommendations
• Participating in the dispute process
• Other duties as assigned

What You Bring

• University degree in any discipline or a college diploma or the CIP designation
• Minimum of 4 yearsClaims handling experience
• Experience handling mediations
• Computer proficient in MS Word and Excel
• Professional, friendly and courteous in all interactions, whether with customers or co-workers
• Perform well in a busy operation and remain calm under pressure
• Team player adaptable to a changing environment
• Strong written and verbal communication skills
• An incredible team of smart, diverse, and supportive people that want to help you be better at what you do
• Great benefits, ongoing education, and competitive pay