Senior Manager, Claims Quality Review

RBC; Mississauga; On-site; CAD 80,000 - 100,000; Full time

Job summary

A leading financial institution in Mississauga is seeking a Claims Management Risk expert to lead portfolio quality reviews. The role requires at least 10 years of experience in Life/Health Claims Adjudication and expert knowledge of various products. The successful candidate will collaborate with key stakeholders to enhance processes and oversee risk assessments. This full-time position offers competitive pay and a supportive environment for professional growth.

Benefits

Flexible benefits

Work/life balance

Career development programs

Investment and retirement savings plans

Competitive pay

Sophisticated software tools for productivity

Qualifications

• Minimum 10 years’ experience in Life/Health Claims Adjudication.
• Expert knowledge of L&H products, risk selection principles, and claims adjudication processes.
• Proven skills in conflict resolution with strong decision making skills.
• Ability to communicate at all levels with clarity and precision.
• Excellent facilitation and presentation skills.
• Experience with data mining and large datasets.

Responsibilities

• Conduct quarterly portfolio quality reviews on Life & Health claims.
• Lead the development and implementation of risk assessments and audit plans.
• Perform independent quality reviews on claims and actuarial reserve data.
• Collaborate with internal partners regarding recommendations.

Skills

Adaptability

Auditing

Commercial Acumen

Detail-Oriented

Internal Controls

Interpersonal Relationship Management

Multi-Level Communication

Organizational Savvy and Politics

Results-Oriented

Waterfall Model

Education

University degree

Insurance designation (FLMI, CEBS, FALU)

Tools

MS Word

Excel

PowerPoint

Job description

Job Description

What is the opportunity?

Play a leadership role by providing an independent and objective review of Claims Management by way of portfolio quality reviews, influencing and collaborating with internal partners to address findings and action recommendations. Liaise with risk management, internal audit, and claims leadership to ensure claims adjudication processes and decisions are aligned with risk appetite and internal controls, presenting opportunities to improve the client experience, simplify processes, and realize efficiencies.

What will you do?

•Conduct quarterly portfolio quality reviews on Life & Health claims adjudication and report results to management identifying trends, gaps, and training opportunities as well as raising issues requiring management action

•Lead the development and implementation of risk assessments and audit plans, and collaborate with internal partners on audit findings and recommendations to support business process optimization, compliance, and internal and external audit

•Perform independent quality reviews on claims and actuarial reserve data to identify and report gaps and anomalies for corrective action and management review

•Be a trusted advisor on special projects as the Claims Management Risk subject matter expert (SME), supporting the development from idea stage through to execution

•Collaborate with Claims, Legal, Group Risk, and 2LOD on recommendations with respect to current processes and claim management guidelines and requirements

What will you need to succeed?

•University degree, insurance designation (FLMI, CEBS, FALU)

•Minimum 10 years’ experience in Life/Health Claims Adjudication, expert knowledge of L&H products, risk selection principles, insurance regulations, and claims adjudication processes

•Proven skills in conflict resolution as well as strong decision making skills

•Ability to communicate at all levels with clarity and precision both written and verbal; proven ability to earn the trust and collaborate with key stakeholders

•Excellent facilitation and presentation skills

•Advanced skills in MS Word, Excel, and PowerPoint, and experienced with data mining and working with large datasets

What's in it for you?

•A Total Rewards program that includes flexible benefits, work/life balance and career development programs and investment and retirement savings plans

•Competitive pay and high-earning potential

•All the tools, training, and team support you need to grow your career

•Flexible work/life balance options

•Sophisticated RBCI software tools to boost your productivity

RBC Insurance is an organization that succeeds by bringing out the best in its people. You’ll be part of a supportive, inclusive team that shares common values – including a fundamental respect for each other. At the heart of this is a commitment to diversity. RBC respects and responds to the many competing and evolving priorities in our lives – so you can focus on what you can do best – putting clients first.

Job Skills

Adaptability, Auditing, Commercial Acumen, Detail-Oriented, Internal Controls, Interpersonal Relationship Management, Multi-Level Communication, Organizational Savvy and Politics, Results-Oriented, Waterfall Model

Additional Job Details

Address:

MEADOWVALE BUSINESS PARK, 6880 FINANCIAL DR:MISSISSAUGA

City:

Mississauga

Country:

Canada

Work hours/week:

37.5

Employment Type:

Full time

Platform:

INSURANCE

Job Type:

Regular

Pay Type:

Salaried

Posted Date:

2025-08-29

Application Deadline:

2025-09-13

Note: Applications will be accepted until 11:59 PM on the day prior to the application deadline date above

Inclusion and Equal Opportunity Employment

At RBC, we believe an inclusive workplace that has diverse perspectives is core to our continued growth as one of the largest and most successful banks in the world. Maintaining a workplace where our employees feel supported to perform at their best, effectively collaborate, drive innovation, and grow professionally helps to bring our Purpose to life and create value for our clients and communities. RBC strives to deliver this through policies and programs intended to foster a workplace based on respect, belonging and opportunity for all.

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