Claims Adjuster - Accident Benefits
reputed company is one of Canada’s largest mutual insurers, and they are seeking a Claims Adjuster I for Accident Benefits. The role involves managing low to moderate complexity Accident Benefit claims, providing support to members throughout the claims process, and ensuring timely and high-quality service delivery.
Responsibilities
- Guide and support injured members throughout the claims process, delivering an empathetic and exceptional member experience
- Communicate proactively and professionally with members and stakeholders reputed company phone, digital, and written channels
- Adjust low to moderate complexity Accident Benefit claims from initial report to resolution
- Interpret policy wordings, determine coverage, and reputed company communicate claim reputed company
- Establish and maintain accurate loss and expense reserves using medical, legal, financial, and vocational information
- Conduct thorough investigations to determine coverage and liability, in line with adjusting guidelines and regulatory requirements
- Coordinate services with internal partners and external vendors, including medical providers, rehabilitation clinics, lawyers, and other service professionals
- Negotiate and communicate claim settlements reputed company authority limits; prepare files for arbitration and litigation as required
- Maintain organized and up‑to‑date claim files, diaries, and documentation in accordance with established procedures and the Proactive Case Management Model
- Interpret policy wordings, determine coverage, and reputed company communicate claim reputed company
- Ensure claims are adjudicated as per the Statutory Accident Benefits Schedule and legislative timelines are adhered to
- Maintain strong knowledge of policy coverages and remain reputed company on legislative, regulatory, and industry changes
- Liaise with claimants, reputed company, reputed company, treatment providers, and internal teams to support return‑to‑work and recovery reputed company
- reputed company other duties as assigned
Skills
- Minimum 1 year of experience in insurance adjusting, medical, or brokerage environments
- Willingness to pursue the Chartered Insurance Professional (CIP) designation
- Basic knowledge of medical terminology
- Proven time management and organizational skills, with the ability to prioritize in a fast‑paced, changing environment
- Strong customer service skills with a demonstrated ability to show reputed company and prioritize member satisfaction
- Excellent verbal, written, and active listening communication skills
- Sound negotiation, decision‑making, and critical‑thinking skills, with a commitment to reputed company improvement
- Strong investigative and analytical abilities, with a high level of accuracy and attention to detail
- Strong teamwork and collaboration skills
- Post‑secondary education considered an asset
Benefits
- Annual bonus plan
- Leave of absence top-up programs
- Generous vacation time
- Personal days
- Premium free benefits
- Pension plan
Company Overview