Specialist, Accident Benefits Claims

Socket.dev; Calgary; Hybrid; CAD 74,000 - 124,000; Full time

Benefits offered by this job

Hybrid work schedule

Company share ownership program

Incentive plans

Pension and RRSP matching

Volunteer days and charitable match

Tuition assistance and education

Inclusion and wellness programs

Discounts on products and services

Job summary

Definity is seeking an experienced Accident Benefits professional to manage complex claims, including catastrophic injuries, permanent impairment, and fatalities, compliant with the Insurance Act and Care First principles. You will mentor teammates, coordinate with legal counsel, and develop strategic file handling plans in a hybrid work environment.

You will review coverage, communicate with customers and providers, and oversee claims processing, reserves, and payment approvals while

Qualifications

• 5 years of experience handling Accident Benefits claims.
• Experience handling Accident Benefits in BC, SK, MB, ON or with WCB/WSIB/WorkSafe BC, etc., or other long-term disability benefit administration.
• Experience coaching others.
• University degree in any discipline or a college diploma in related field or the CIP designation.
• Excellent verbal and written communication skills.
• Professional, friendly and courteous in all interactions with customers or co-workers.
• Ability to perform well in a busy operation and remain calm under pressure.
• Team player adaptable to a changing environment.
• Strong written and verbal communication skills.

Responsibilities

• Investigate, evaluate benefits, and administer Care First principles under Insurance Act.
• Secure details of claims from customers, care providers, or representatives.
• Communicate with customers and health care practitioners regularly.
• Handle complex Accident Benefits claims including catastrophic injuries and permanent impairment.
• Process income replacement, non-earner, loss of studies, caregiver, fatality and other benefits.
• Handle disputes with/without legal counsel.
• Formulate file handling strategies and work plans.
• Work with legal counsel on file matters.
• Provide coaching and support on file handling to team members.
• Assess coverage eligibility and interpret policy wordings to resolve issues.
• Apply Priority Rules to each claim file.
• Reserve files after assessing claim.
• Maintain detailed electronic claim records.
• Process payments after confirming benefits, eligibility and reserves.
• Coordinate the most effective action for claims.
• Respond to customer correspondence per applicable legislation.
• Review and approve treatment plans for customer rehabilitation.
• Arrange medical assessments and relay recommendations.
• Other duties as assigned.

Skills

5 years experience

Education

University degree or college diploma or CIP

Job description

The Opportunity

This role is suited for a highly experienced Accident Benefits professional with strong technical expertise in complex claims management and dispute resolution. Reporting to the Team Leader, Accident Benefit Claims, you will manage a portfolio of complex claims, including catastrophic injuries, permanent impairment, and fatality benefits, while ensuring compliance with the Insurance Act and the organization's Care First principles. In addition to providing exceptional service to customers and stakeholders, you will collaborate closely with legal counsel, develop strategic file handling plans, and serve as a mentor and resource to team members by providing coaching and guidance on complex claims matters.

What to Expect

• Report to the Team Leader, Accident Benefit Claims, while investigating, evaluating benefits, and administering the principles of Care First in accordance with the Insurance Act
• Securing details of claims by corresponding with customers, care providers, and/or representatives
• Regular communication with the customer and their health care practitioner(s)
• Handling complex Accident Benefits claims including those involving catastrophic injuries and permanent impairment
• Processing income replacement, non-earner, loss of studies, caregiver, fatality, and other benefits
• Handling ACT disputes with and without legal counsel
• Formulating file handling strategies and work plans
• Working with legal counsel
• Providing coaching and support on file handling to Accident Benefit team members.
• 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
• 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 customer correspondence and forms in accordance with the applicable legislation
• Reviewing and approving, when appropriate, treatment plans for customer rehabilitation.
• Arranging medical assessments as necessary and reviewing and relaying recommendations
• Other duties as assigned

What You Bring

• 5 years of experience handling Accident Benefits claims
• Experience handling Accident Benefits in British Columbia, Saskatchewan, Manitoba, Ontario, or experience with WCB/WSIB/WorkSafe BC, etc. or experience with other long-term disability benefit administration
• Experience coaching others.
• University degree in any disciplineora college diplomain related fieldorthe CIP designation
• Excellent verbal and written communication skills
• 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.

Salary Range: $73,500 - $123,500

Actual salary for the role may vary depending on work location of the successful candidate and other factors including but not limited to, skills, education, experience, working conditions and the local labour market.

This position is being posted to fill an existing vacancy.

Interested in this role, but don’t meet every requirement? We know from experience that a candidate doesn’t need 100% of the qualifications listed to bring incredible value to our team. We’re actively seeking diverse backgrounds and perspectives to help us make insurance better. At Definity, inclusion, diversity, and equity aren’t just “nice to have” — they’re essential to our success.

What’s in it for you?

• Hybrid work schedule for most roles
• Company share ownership program
• Incentive Program - Eligible employees may participate in various incentive plans which are paid out at the discretion of the company and subject to individual and company performance.
• Pension and savings programs, with company-matched RRSP contributions
• Paid volunteer days and company matching on charitable donations
• Educational resources, tuition assistance, and paid time off to study for exams
• Focus on inclusion with employee groups, support for gender affirmation surgery, access to BIPOC counsellors, access to programs for working parents
• Wellness and recognition programs
• Discounts on products and services

Go ahead and expect a lot — you deserve it.

It’s better here — but don’t take our word for it. Definity was named by Great Place to Work as one of the Best Workplaces in Canada for women, for youth, and for inclusion.

Our inclusive work environment welcomes diversity and supports accessibility. If you require accommodation at any time during the recruitment process, please let us know by contacting [e-mail].

As part of Definity’s commitment to reconciliation, we acknowledge that our work, meetings, and travel take place on the lands now known as Canada, and recognize the enduring presence, wisdom, and stewardship of the First Nations, Métis, and Inuit peoples who have long cared for these lands.

Background checks

This role requires successful clearance of background checks (including criminal checks and leadership references).

Definity is the parent company to some of Canada’s most long-standing and innovative insurance brands, including Economical Insurance, Sonnet Insurance, Family Insurance Solutions, and Petline Insurance. Our ambition is to be one of Canada’s leading and most innovative property and casualty insurers. We can’t do that without our people, so we embrace and encourage a culture that’s collaborative, ambitious, rewarding, and empowering.

We offer a flexible, hybrid work experience where employees work from the office and virtually depending on the type of work they are doing and who they are working with. Bring your true self and be a part of our journey. It’s better here.