The Opportunity: Accident Benefits Claims Representative IIIAs an Accident Benefits Claims Representative III, you'll investigate, evaluate, reserve, negotiate and resolve assigned automobile accident benefits claims by:
- Reviewing new losses, developing investigation plans, gathering statements, obtaining necessary documentation (medical records, authorizations, forms), and applying regulatory classifications accurately.
- Communicating with policyholders, treatment providers, investigators, accountants, and medical professionals to assess injuries, financial losses, and determine claim eligibility.
- Utilizing systems like HCAI, applying dispute resolution techniques, and leveraging structured settlements and independent medical exams to ensure fair and timely claim outcomes.
We're looking for a detail-oriented, enthusiastic team player who embodies our company values and is committed to providing top-notch service.
What You'll Do:- Review new losses, prepare an investigation plan, and contact the insured to discuss loss details.
- Work with policyholders to explain claims process in a clear and concise manner to ensure an efficient claims experience.
- Secure statements with policyholders, third parties, independent witnesses, passengers as necessary.
- Secure medical authorization, statutorily required forms, and medical opinions as necessary.
- Arrange appropriate independent medical examinations to aid in the assessment of coverage, injuries and damages.
- Asses the need and retain licensed investigators to assist in understanding injury severity.
- Work with accountants to asses income and other financial losses related to accident benefit coverages.
- Review complex policy wordings and legislation to assess coverage eligibility.
- Communicate verbally and in writing to policyholders and brokers coverage positions.
- Review complex medical forms and reports to determine benefit payment eligibility.
- Negotiate settlements based on results of loss investigation, coverage analysis and damage assessment within authority limits.
- Complete ongoing follow up communication per corporate service standards with all file stakeholders to bring claim to resolution.
- Mentor junior and intermediate team members and contribute to training, quality, and process improvement initiatives.
- Attend industry events to network with brokers and vendors in a manner that portrays Portage Mutual Insurance in a positive light.
What You'll Bring:- Minimum 5-7 years experience with injury claims with visibility of more complex.
- Proficient in Microsoft Office Suite and relevant claims systems (e.g., Guidewire), with the ability to adapt to new technologies.
- Consistently applies accuracy, thoroughness, and meticulousness in all aspects of work.
- Strong critical thinking and problem-solving skills to assess the strengths and weaknesses of each claim within authority limits.
- Ability to work independently or as a collaborative team and is self-motivated to work in a fast-paced changing environment.
- Demonstrated leadership skills, with experience in training, mentoring, and guiding team members.
- Excellent verbal and written communication skills.
- High level of confidentiality.
- Post secondary education in business, nursing, health care aid, insurance or medical reception preferred.
- CIP designation completed, actively in progress, or willing to work towards.
The targeted pay range for this position in the following location is:
Canada - Alberta: $76,600 - $95,800 CAD / Annual
Our pay ranges reflect the minimum and maximum target for new hire pay for the full-time position determined by role and level.
The pay range shown is based on our compensation structure in place at the time of posting and may be updated periodically based on business needs. Individual pay is based on additional factors including job-related skills, experience, and relevant education and/or training.
Portage Mutual uses artificial intelligence and automations in its recruitment practices for activities that may include searching for qualified candidates, screening applications, preparing interview questions, recording interviews, drafting transcripts and other administrative tasks. AI is never used for decision making purposes.
Ready to Make an Impact?If you're seeking a rewarding career with a company that values its employees and is committed to making a difference, we invite you to apply! If you have the qualifications we are seeking and would thrive in a work environment where you are valued and respected, please apply!
Please submit your resume and cover letter!
We thank you for your interest in Portage Mutual Insurance, however, only those selected for an interview will be contacted. (No agencies please).
