Claims Advisor- Accident Benefits

Claims Advisor Accident Benefits

The Accident Benefits (AB) Claims Advisor investigates, evaluates, and manages low- to moderate-complexity claims—particularly those under the Minor Injury Guideline—by confirming coverage, collecting and reviewing documentation, setting reserves, negotiating and settling claims, coordinating medical management, and guiding claimants through the process with clear, timely, and good-faith communication, while also providing front-line support to vendors, clinics, and insureds and ensuring compliance with FSRA and all applicable legal and regulatory requirements.

What you will do:

• Reviewing, investigating and documenting medical reports and claim related information and the appropriate setting of AB Claims reserves.
• Negotiation and Settlement of claims of low to moderate complexity. This occasionally includes preparing and presenting files for authority or strategic approval.
• Supports claims through the timely review and adjudication of Medical Treatment and Assessment Plans, within authority
• Direct communications with claimants/ guardians (phone or written) for medically managed claim files
• Communication between internal and external legal counsel, case managers, and outside vendors
• Invoicing and administrative tasks

What you need to succeed:

• Post secondary Education
• CIP designation is an asset
• 2 years of Claims Handling Experience

• Capable problem solving and dispute resolution

• Experience working by phone

• Successful hybrid/work from home experience

• Previous exposure to APD handling

• Previous exposure to AB Admin role is of great value

The expected base salary range for this position is $52,500 - $86,500. Depending on your relevant experience, skills, qualifications, market conditions and business needs, base compensation may vary. You have the potential to earn more through Gore Mutual’s discretionary bonus program which gives you an opportunity to increase your total compensation, provided the business meets its performance targets and you meet your individual goals.

Please note: This range reflects the expected base salary for this role but may not represent the full compensation range for all experience and skill levels. During the recruitment process, we will discuss and consider how your unique qualifications align with the broader range for this position.

Gore Mutual is proud to offer a comprehensive total rewards package which includes extended health and dental benefits, disability insurance, retirement plan matching, paid time off, recognition and perk programs.

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