Job DescriptionThe OpportunityThis role is suited for a highly experienced Accident Benefits professional with strong technical expertise in complex claims management and dispute resolution. Reporting to the Team Leader, Accident Benefit Claims, you will manage a portfolio of complex claims, including catastrophic injuries, permanent impairment, and fatality benefits, while ensuring compliance with the Insurance Act and the organization's Care First principles. In addition to providing exceptional service to customers and stakeholders, you will collaborate closely with legal counsel, develop strategic file handling plans, and serve as a mentor and resource to team members by providing coaching and guidance on complex claims matters.
What to Expect- Report to the Team Leader, Accident Benefit Claims, while investigating, evaluating benefits, and administering the principles of Care First in accordance with the Insurance Act
- Securing details of claims by corresponding with customers, care providers, and/or representatives
- Regular communication with the customer and their health care practitioner(s)
- Handling complex Accident Benefits claims including those involving catastrophic injuries and permanent impairment
- Processing income replacement, non-earner, loss of studies, caregiver, fatality, and other benefits
- Handling ACT disputes with and without legal counsel
- Formulating file handling strategies and work plans
- Working with legal counsel
- Providing coaching and support on file handling to Accident Benefit team members.
- Assessing coverage eligibility and reviewing and applying interpretations of policy wordings in the resolution of coverage issues
- Applying applicable Priority Rules chart to each claim file
- Reserving files appropriately after assessing claim
- Maintaining detailed file records on an electronic claims system
- Processing payments after confirming benefits, eligibility and reserves
- Coordinating the most effective course of action for claims
- Responding to customer correspondence and forms in accordance with the applicable legislation
- Reviewing and approving, when appropriate, treatment plans for customer rehabilitation.
- Arranging medical assessments as necessary and reviewing and relaying recommendations
- Other duties as assigned
What You Bring- 5 years of experience handling Accident Benefits claims
- Experience handling Accident Benefits in British Columbia, Saskatchewan, Manitoba, Ontario, or experience with WCB/WSIB/WorkSafe BC, etc. or experience with other long-term disability benefit administration
- Experience coaching others.
- University degree in any discipline or a college diploma in related field or the CIP designation
- Excellent verbal and written communication skills
- Professional, friendly and courteous in all interactions, whether with customers or co-workers.
- Perform well in a busy operation and remain calm under pressure.
- Team player adaptable to a changing environment.
- Strong written and verbal communication skills.
Salary Range: $73,500 - $123,500
Actual salary for the role may vary depending on work location of the successful candidate and other factors including but not limited to, skills, education, experience, working conditions and the local labour market.
This position is being posted to fill an existing vacancy.
Interested in this role, but don't meet every requirement? We encourage you to apply! We know from experience that a candidate doesn't need 100% of the qualifications listed to bring incredible value to our team. We're actively seeking diverse backgrounds and perspectives to help us make insurance better. At Definity, inclusion, diversity, and equity aren't just "nice to have" - they're essential to our success.
What's in it for you?- Hybrid work schedule for most roles
- Company share ownership program
- Incentive Program - Eligible employees may participate in various incentive plans which are paid out at the discretion of the company and subject to individual and company performance.
- Pension and savings programs, with company-matched RRSP contributions
- Paid volunteer days and company matching on charitable donations
- Educational resources, tuition assistance, and paid time off to study for exams
- Focus on inclusion with employee groups, support for gender affirmation surgery, access to BIPOC counsellors, access to programs for working parents
- Wellness and recognition programs
- Discounts on products and services
Go ahead and expect a lot - you deserve it.#LI-Hybrid
About the TeamDefinity is the parent company to some of Canada's most long-standing and innovative insurance brands, including Economical Insurance, Sonnet Insurance, Family Insurance Solutions, and Petline Insurance. Our ambition is to be one of Canada's leading and most innovative property and casualty insurers. We can't do that without our people, so we embrace and encourage a culture that's collaborative, ambitious, rewarding, and empowering.
We offer a flexible, hybrid work experience where employees work from the office and virtually depending on the type of work they are doing and who they are working with. Bring your true self and be a part of our journey. It's better here.
