Claims Adjuster 1 - Accident Benefits

Job Overview

The Claims Adjuster 1, Accident Benefits contributes to Wawanesa's goal of delivering an exceptional and consistent member experience through the fair and equitable adjustment of low to moderate complexity accident benefit claims. This role is responsible for applying and explaining policy coverages and documenting claim files through the life of a claim. The role is accountable for providing timely service and prompt management of your claims pending from initial report to conclusion. This position will require the successful candidate to commit to attending in-person training, based out of our North York office, for a period of four (4) full weeks, starting on March 4th 2024.

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 low to moderate complexity.
• 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 from various sources such as medical, legal, financial, and vocational.
• 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. Communicating claim decisions promptly and effectively, while still delivering an exceptional member experience. Prepares files for arbitration and litigation.
• 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, doctors and rehabilitation specialists Doctors, Lawyers, Employers, Treatment Providers, Case managers, Clinical Resource Team, Return to Work Team, and Injured Members in accordance with Wawanesa's Proactive Case Management approach.
• Manage Loss Transfer & WSIB exposure. LAT process management & priority disputes. Manage priority of payment investigation, WSIB and Loss Transfer.
• Perform other duties as assigned.

Qualifications

• Exceptional customer service skills demonstrating empathy and concern for member satisfaction.
• 1 year of insurance adjusting experience or equivalent is preferred.
• Post-secondary degree is preferred.
• Willingness to work toward Chartered Insurance Professional (CIP) designation and where required, dedicated to reach the proper licensing requirements.
• Basic knowledge of medical terminology.
• Excellent communication skills; listening, written, and spoken.
• Excellent investigative and analytical skills. Detail oriented with a high degree of accuracy regarding data entry.
• Excellent time management and organizational skills with the ability to prioritize work in a fast paced, changing environment.
• Good negotiation, decision making and critical thinking skills as well as a willingness to improve.
• Strong teamwork skills with the ability to collaborate with others.

#LI-Hybrid