Senior Claims Examiner

DGA Careers Inc.; Toronto; Hybrid; CAD 75,000 - 120,000; Part time

Job summary

DGA Careers Inc. is seeking a Claims Examiner for a contract role in the Toronto area. The position involves managing a portfolio of complex liability files, directing adjusters and defence counsel, setting reserves, and negotiating through to settlements or defense.

Eligible candidates will have 5–10+ years in liability claims, with knowledge of CGL and occupiers' liability, and a solid understanding of the litigation process. Strong analytical, communication, and MS Office skills are essential.

Qualifications

• 5-10+ years of liability claims experience with CGL and occupiers' liability.
• Strong understanding of the litigation process: statements of claim, mediation and pre-trial preparation.
• Advanced Microsoft Office skills (Outlook, Word, Excel).

Responsibilities

• Review initial claim documentation, confirm coverage, apply legal and claims analysis, and set and amend reserves
• Instruct adjusters and defence counsel on an ongoing basis and make settle/deny/defend decisions
• Ensure evidence and information are properly collected and preserved
• Authorize mediation and pre-trial expenses, and represent the organization at mediations and pre-trials
• Lead negotiations with plaintiff counsel, mediators, pre-trial judges and claimants
• Make settlement decisions up to the posted reserve and authorize payments
• Handle complex and specialty files, including serious injury, surgical and medical liability matters, privacy breaches and class actions
• Interpret policy wording and provide analysis and recommendations on non-claim matters
• Provide guidance on general risk management questions and work with internal risk and insurance teams
• Liaise with Finance to verify transactions
• Train junior staff and present on claims matters when required

Job description

Our client, a well-established Canadian liability insurer, is looking for a Claims Examiner to join its claims team on a contract basis. This is a hands-on, self-directed role for someone who can step in and be productive from day one.

Retired or semi-retired professionals who are open to returning for a defined term, are encouraged to apply.

About the Role

You'll manage a portfolio of complex, often litigated liability files. You are the decision-maker on each claim: you direct adjusters and defence counsel, set reserves, and control negotiations through to settlement or defence.

Key Responsibilities

• Review initial claim documentation, confirm coverage, apply legal and claims analysis, and set and amend reserves
• Instruct adjusters and defence counsel on an ongoing basis and make settle/deny/defend decisions
• Ensure evidence and information are properly collected and preserved
• Authorize mediation and pre-trial expenses, and represent the organization at mediations and pre-trials
• Lead negotiations with plaintiff counsel, mediators, pre-trial judges and claimants
• Make settlement decisions up to the posted reserve and authorize payments
• Handle complex and specialty files, including serious injury, surgical and medical liability matters, privacy breaches and class actions
• Interpret policy wording and provide analysis and recommendations on non-claim matters
• Provide guidance on general risk management questions and work with internal risk and insurance teams
• Liaise with Finance to verify transactions
• Train junior staff and present on claims matters when required

What We're Looking For

• 5-10+ years of liability claims experience, with a strong working knowledge of CGL, occupiers' liability and litigated files
• Solid understanding of the litigation process: statements of claim, mediation and pre-trial preparation
• Sound judgment, analytical thinking and common sense. You can read a policy, confirm coverage, set a reserve and defend your reasoning
• Comfortable challenging counsel's recommendations when needed
• Clear, concise written and verbal communication, including the ability to summarize complex reports in a few words
• CIP, FCIP and/or CRM completed or in progress
• Professional liability or medical malpractice experience is an asset, but not required
• Experience at an insurer, independent adjusting firm, or a self-insured organization will be considered
• Advanced Microsoft Office skills (Outlook, Word, Excel)
• Valid G driver's licence and access to a vehicle

Details

• Contract: approx.12 to 15 months
• Location: Toronto area, hybrid (2 days per week in office)
• Hours: Monday to Friday, 8:30 AM to 4:30 PM
• Compensation: $75 000 to 120 000 Depending on experience can be examiner or Senior examiner level.