Bilingual Claims Adjuster 1 or 2 - Accident Benefits

Job Overview

The Bilingual Claims Adjuster, Accident Benefits (Levels 1 & 2) supports Wawanesa’s commitment to delivering consistent and exceptional member experience through the fair and timely adjustment of moderate accident benefit claims. This role is responsible for assessing coverage, managing claim files from initial report to resolution, and providing clear, empathetic service throughout the claims lifecycle.

Key Responsibilities

• Provide guidance and support to injured members, delivering exceptional member experience with empathy and professionalism.
• Communicate proactively and effectively with members and stakeholders through verbal, digital, and written channels.
• Adjust moderate to high‑complexity accident benefit claims, including coverage determination and decision communication.
• Review and interpret policy wordings and explain coverage decisions clearly to members.
• Establish and maintain accurate loss and expense reserves based on medical, legal, financial, and vocational information.
• Conduct thorough investigations to determine coverage and liability, engaging internal and external resources as required.
• Coordinate services with external vendors, including legal, medical, and rehabilitation professionals.
• Negotiate and communicate claim settlements within authority limits.
• Maintain accurate file documentation and diary management in accordance with established procedures and Wawanesa’s Proactive Case Management Model.
• Maintain knowledge of policy coverages, regulatory requirements, and industry trends.
• Liaise with internal teams and external stakeholders to support effective claim outcomes.
• Contribute to employee development through training, coaching, and technical guidance, as applicable.
• Perform other related duties as assigned.

Qualifications

• Commitment to working toward the Chartered Insurance Professional (CIP) designation and required licensing.
• Completion of a post‑secondary degree, diploma, or certificate.
• Experience in insurance or a medical environment; knowledge of medical terminology is an asset.
• Strong decision‑making, critical thinking, and analytical skills with high attention to detail.
• Excellent communication skills (written, verbal, and listening).
• Strong organizational and time‑management skills with the ability to prioritize in a fast‑paced environment.
• Proven teamwork and collaboration skills.
• Exceptional customer service skills with a demonstrated ability to communicate with empathy.
• Bilingualism in French/English is required.
• Negotiation skills are an asset.