AB Claims Representative II

Located in Ontario and Nova Scotia, Heartland Mutual Insurance strives to be the Best Mutual. Our team of talented and dedicated professionals challenge the norm and strive to be extraordinary. It’s all about fulfilling our promise with a personal approach. With our team, you’ll bring this purpose to life every day by living our values, being open to change, and pursuing your career aspirations.
Manage a caseload of moderate to serious injury accident benefit files. This is a telephone adjusting position. Files are generally those where injuries interfere with the claimant’s ability to work, or to perform their daily living activities, and are considered more costly exposures to manage in terms of disability period, type and number of treatment modalities, pre-existing medical conditions or prior injuries, and other complicating factors. Claimants are often represented by legal counsel.
What you will do...

• Handle Accident Benefits Claims in Nova Scotia and Ontario
• Interview claimants to ensure we have adequate information to confirm priority of payment, WSIB and/or loss transfer potential.
• Provide counsel and direction to claimants regarding SABS, benefit eligibility, claims process and procedures, including use of FSRA approved forms or formal correspondence, as required.
• Manage treatment plans and invoicing within the HCAI system--arrange for timely payment, and response within regulation timelines.
• Working with our legal counsel where disputes have been filed through the LAT.
• Request and review medical records, summarizing key information in the file journal.
• Ensure all files are tracked and kept up-to-date through consistent use of our diary system.
• Process specified benefit cheques within guidelines.
• Ensure adequate reserving throughout the life of the file.
• Co-ordinate medical examinations with the AB Claims Assistant, as required.

What you will bring...

• Accountable for claims at all transaction levels including, coverage interpretation, evaluation, reserve adjustments, payments, written and verbal communication, expert requirements, and internal reporting requirements
• Consults as required for authority requests with respect to payments, settlements, and incurred handling.

What we offer...
In return, we’ll give you countless opportunities to learn and grow. You’ll be empowered to be your best self, do your best work, and make a meaningful impact. Here, you can help shape the future of insurance, win as a team, and grow with us.
At Heartland our benefits are great and include not only health and dental coverage, but also a generous pension plan. All staff members share in our company’s success through our incentive plan. And with our hybrid work model, you get the best of both worlds – the ability to collaborate and connect with great colleagues and to enjoy the benefits of working from home.
Intrigued? We can’t wait to hear from you!
If you have the qualifications we are seeking and would thrive in a work environment where you are valued and respected, please apply on the company website. Accommodations are available on request for candidates taking part in all aspects of the selection process.
A Place Where YOU Can Make a Difference! Proudly Canadian. Mutually Owned.