Claims Adjuster Level 3 - Accident Benefits

Job Overview

As a Claims Adjuster 3, Accident Benefits, you’ll play a key role in delivering Wawanesa’s exceptional and consistent member experience by fairly and equitably adjusting high-complexity and large loss accident benefit claims. You’ll apply and clearly explain policy coverages, maintain strong, well-documented claim files throughout the life of each claim, and provide timely, proactive service—owning your pending from initial report through to resolution.

Job Responsibilities

• Provide direction and support to our injured members through throughout the claims process, by providing an exceptional member experience delivered with empathy. 
• Timely and proactive communication, through voice to voice, digital and written correspondence, ensuring that all inquiries are effectively dealt with in a timely and professional manner.
• Adjustment of Accident Benefit claims of high complexity and large loss.
• Review and interpret policy wordings, determine policy coverage, and communicate coverage decisions to members.
• Establish timely and accurate loss and expense reserves throughout the life of the claim through evaluation of relevant information
• Ensure a comprehensive investigation is conducted on all files to determine coverages and liability, while adhering to Wawanesa’s adjusting guidelines, and recognizing when to engage appropriate internal and external resources.
• Coordinate and manage services with vendors and service providers such as accountants, lawyers, rehabilitation clinics and health practitioners.
• Negotiating and conveying claim settlements within authority limits. Manage claims in litigation, mediation, or arbitration. Provide instruction to assigned counsel.
• Maintain an effective and current diary system and document claim file activities in accordance with established procedures and Wawanesa's Proactive Case Management Model.
• Demonstrate and maintain knowledge and understanding of policy coverages, while complying with regional regulatory and licensing requirements (as applicable). Remaining current with legislative changes and trends in the insurance industry.
• Liaise with claimants and all other parties involved.
• Occasionally participation in private mediation, court proceedings and other dispute resolution as required.
• In Ontario: LAT process management & priority disputes. Manage priority of payment investigation, WSIB and Loss Transfer.
• Contribute to employee development through training, technical guidance, and coaching.
• Perform other duties as assigned.

Qualifications

• At least 3+ years of progressive insurance adjusting experience.
• Ability to adapt quickly to change and remain flexible in a dynamic work environment.
• Well-developed investigative, analytical, and critical-thinking skills.
• Working knowledge of medical and legal terminology.
• Completion of, or active progress toward, the Chartered Insurance Professional (CIP) designation.
• Post-secondary education is considered an asset.
• Excellent time management and organization, with the ability to prioritize in a fast-paced, changing environment.
• Sound judgment and confident decision-making, with the ability to stand behind decisions.