Senior Claims Advisor- Accident Benefits

2 Vacancies

An Accident Benefits (AB) adjuster is responsible for evaluating the validity of claims and guiding claimants through the insurance process. They assess the extent of coverage under the policy, ensuring all necessary documentation is completed and submitted. Acting as the main point of contact, they address any questions or concerns from claimants, providing clear explanations of coverages, deductibles, and the steps involved in the claims process. They process claims promptly and fairly, adhering to legal and regulatory requirements set by the Financial Services Regulatory Authority of Ontario (FSRA). They are expected to act in good faith, avoiding unreasonable denial of benefits and ensuring compliance with all relevant laws and regulations. The AB Senior role is responsible for investigating, evaluating, reserving, negotiating, medically managing and settling MIG and Non-Catastrophic AB claims of moderate complexity and value (IRB, Non-Earner/Priority loss transfers within authority). They also serve as formal and informal mentors to our Med Desk adjusting Team.

What will you 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 moderate complexity.

• This occasionally includes preparing and presenting files for authority or strategic approval as well as attending hearings or case conferences.

• 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.

• Coaching and mentoring Med Desk Team.

• Invoicing and administrative tasks.

What will you need to succeed?

• Post Secondary Education: Typically a relevant degree/diploma in insurance or a related field.

• Work Experience:

• 5 years of AB Claims Handling experience strongly preferred

• Exposure to LAT Handling process.

• Capable dispute resolution.

• Some litigation management for AB.

• Experience attending and achieving desirable file resolutions through Settlement Conferences.

• Opportunities for internal promotion based on performance and potential.

Skills:

• Effective Communication.

• Critical Judgement and Decision Making.

• Resilience.

• Attention to Detail.

• Claims Negotiation and Settlement.

• Assessment and interpretation of medical reports and injuries.

• Claims Evaluation and Investigation.

• Dispute and Litigation Management for AB Ontario.

• Advanced understanding of SABS.

• Mentoring.

Location: We’re a hybrid team that thrives on the energy and value of in-office collaboration. This role offers the best of both worlds, with 2 days a week spent in our vibrant office in Cambridge, Ontario

Gore Mutual Insurance is committed to providing accommodations for people with disabilities during all phases of the recruiting process, including the application process. If you require accommodation, please let us know.

The expected base salary range for this position is $56,000 - $103,500. 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.

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