Position Overview
- Expertly adjudicate assigned claims, communicate critical issues and claim handling requirements clearly. and professionally to clients and capture data effectively and efficiently.
- Evaluate and proactively support clients in enhancing claim practices via training or one-on-one discussions.
- Contribute to internal claims department initiatives and selected internal projects.
- Share business-critical knowledge across team and organization.
Your role:Claim Adjudication
- Conduct expert individual claim adjudication within internal quality standards, delegated authority limits and client response timelines.
- Identify coverage and payment discrepancies, address and resolve coverage anomalies.
- Proactively identify, assess, manage and resolve claim evidence inconsistencies with clients.
- Promptly approve payments in accordance with payment authorization protocols and client service level agreements.
- Archive all claim documentation in an appropriate and orderly manner, perform required claim file follow ups.
- Utilize data management and claim system software and tools effectively to adjudicate and monitor claim risks.
Client Management
- Establish strongly positive, beneficial, long-term client relationships through professional, timely and knowledgeable communication.
- Monitor client claim results and provide accurate client information on a timely basis to Management through claim analytics, data mining and trend analysis.
- Assist with identifying/implementing initiatives to enhance claim handling efficiencies and effectiveness.
- Develop and implement strategies to track and improve claim results or client expertise.
Risk Monitoring and Claim Audits
- Validate treaty compliance during client claim audits, communicate findings to internal business partners, and provide best practice recommendations for action/resolution.
- Produce excellent written analytical client audit reports with sound recommendations within expected timeframes.
- Follow up on recommended client actions to improve client review results.
- Present claims to Senior Management for evaluation/authority including completion of pertinent claim summary reports and notice of high exposure claims.
Knowledge Transfer
- Provide technical mentoring on complex claims to clients or internal Claims team members.
- Develop and deliver leading-edge knowledge of insurance claim investigations and practices through presentations, surveys and publications.
- Engage with pricing, underwriting, and legal to ensure treaty and contractual liabilities, product language and client decisions meet Munich Re's risk standards and intent.
- Apply expert risk management knowledge/analysis to claim scenarios and share expertise throughout the organization.
Your Profile:
- Minimum 3+ years in insurance claims, with primary expertise in Individual or Group Disability claims, and/or Long Term Care, Critical Illness as well as Life claims. Reinsurance experience is an asset.
- Bilingual in English/French, with demonstrated verbal and written proficiency required.
- Demonstrated ability to build solid client relationships. Experience in customer service/call centre is an considered an asset.
- University degree in combination with LOMA, ICA or other insurance designations.
- Requirement to work in Toronto office under hybrid work model
- Demonstrated thoroughness, accuracy and attention to detail in claim reviews and data capture.
- Strong analytical and inquisitive skills.
- Excellent attention to meeting time service and achieving deliverables.
- High degree of self-motivation, continuing development and proven ability to work independently.
- Demonstrated desire and aptitude to learn multiple lines of business and claim types.
- Excellent presentation and report creation and delivery skills, strong verbal and written communication skills.
- Knowledge of Underwriting concepts and medical terminology is an asset.
- Power BI and related coding skills is an asset.
- Limited travel within Canada is expected.
Our base salary range for this role is between
$112,670and $130,460 per year, plus an opportunity for an annual company bonus based upon a percentage of eligible pay. The salary estimate displayed represents the typical salary range for candidates hired in this position. Factors that may be used to determine your actual salary include your specific skills, how many years of experience you have and comparison to internal equity.
This role is located in our
Toronto office on 390 Bay St, and we operate in a
hybrid work model. This job posting is for an existing vacancy.
We do not use AI in our recruitment process - applications are reviewed by our team to ensure a fair and personalized experience.
Please note that only candidates who are selected for interview will be contacted directly. We thank all candidates for their interest.
