Senior Specialist, Accident Benefits Claims

Senior Specialist, Accident Benefits Claims Waterloo, ON, Canada Job Description Posted Thursday, September 25, 2025 at 4:00 AM At Heartland Mutual Insurance, we’re more than just a company — we’re a community. Proudly rooted in Ontario and Nova Scotia, we’re driven by a bold vision: to be the Best Mutual. Our team of passionate professionals doesn’t just follow the norm — we challenge it. We think differently, aim high, and deliver on our promise with a personal touch. Here, you’ll be part of a culture that values authenticity, embraces change, and empowers you to make a meaningful impact every day. Together, we bring our purpose to life by living our values and putting people first. Senior Specialist, Accident Benefits Claims - Waterloo, Ontario The Senior Specialist, Accident Benefits Claims is a player-coach role emphasizing expert adjudication of complex injury cases, including catastrophic impairments, extensive mentoring, and coaching of junior and intermediate staff. This role handles escalated customer and adjuster concerns, collaborates closely with QA and Training Specialists, identifies potential fraudulent activities, and ensures adherence to regulatory compliance. The Senior Specialist champions continuous improvement, strategic initiatives, and promotes an environment of excellence, professional development, and outstanding customer service. What you’ll do... Claims Adjudication and Technical Expertise: Effectively manage a complex caseload, adjudicating claims involving catastrophic injuries in compliance with Ontario SABS. Independently manage LAT case conferences and provide informed direction to defense counsel. Ensure accuracy and adequacy of reserves, maintaining rigorous compliance with corporate guidelines. Conduct detailed reviews and technical oversight on complex files, ensuring adherence to regulatory standards. Regularly review evolving case law, regulatory changes, and industry best practices, ensuring claims handling remains current and highly effective. Act as a technical advisor for adjusters handling challenging claims, providing expertise, strategic advice, and ongoing support. Participate in strategic case reviews and settlement discussions, ensuring optimal outcomes for claimants and the organization. Develop and maintain detailed, accurate documentation within the claims management system, ensuring thorough audit trails. Mentorship and Staff Development: Provide comprehensive mentoring and coaching to junior and intermediate adjusters, enhancing their technical skills and professional competencies. Conduct regular file audits, delivering constructive feedback and promoting best practices. Guide staff in setting meaningful career and performance objectives aligned with departmental and corporate goals. Facilitate training and development opportunities, fostering a continuous learning culture. Complete performance evaluations and support performance improvement strategies where necessary. Escalation and Complaint Management: Manage and resolve escalated issues from claimants, legal representatives, brokers, and adjusters with professionalism and sensitivity. Triage and handle complaints effectively, determining appropriate resolutions or escalating further when required. Maintain open and transparent communication with all stakeholders throughout the resolution process. Fraud Identification and Investigation: Proactively identify and investigate potentially fraudulent claims, collaborating closely with adjusters. Refer significant fraud concerns to the Senior Special Investigator, ensuring timely and accurate information transfer. Continuously educate and mentor staff on fraud detection strategies. Collaboration with QA and Training Teams: Work closely with the QA Specialist to refine audit processes and uphold claims quality standards. Collaborate with the Training Lead in designing, developing, and delivering comprehensive training resources to enhance staff technical capabilities. Support corporate initiatives and strategies through active participation and expertise. Regulatory Compliance and Customer Relations: Ensure daily claims practices comply fully with legal, regulatory, and privacy obligations. Build and maintain strong relationships with customers, claimants, legal representatives, and internal stakeholders through professionalism and accountability. Stay current with regulatory changes, proactively updating processes and staff training to ensure ongoing compliance. Provide timely and accurate responses to regulatory inquiries and audits, ensuring all compliance documentation is thorough and readily available. Proactively seek customer feedback, analyzing trends to identify areas for service improvements and implement necessary actions. Foster a strong customer-service culture within the team, emphasizing empathy, clarity, and timely communication in all customer interactions. Champion customer advocacy by actively identifying ways to simplify claims processes and enhance claimant satisfaction. What you’ll bring... Education & Experience: Minimum 8 years of Accident Benefits claims handling experience with substantial catastrophic file exposure. Comprehensive understanding of Ontario SABS and OAP 1. Prior experience in auto physical damage adjusting preferred. College diploma or relevant post-secondary certificate; CIP designation or current enrolment preferred. Technical Skills & Knowledge: Advanced expertise in claims adjudication and reserve management. Proficient in claims management systems and digital workflows. Strong knowledge of dispute resolution processes (ADR and LAT). Exceptional leadership, mentorship, and coaching capabilities. Outstanding communication, negotiation, and interpersonal skills. Ethical, accountable, and customer-centric approach. Ability to manage complex, sensitive situations with professionalism and strategic insight. Strong analytical, organizational, and problem-solving skills. 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. Accommodation is available on request for candidates taking part in all aspects of the selection process. What’s in it for You: Join a Supportive Team:Be part of a collaborative and high-performing team that values knowledge sharing and celebrating wins together. Comprehensive Total Rewards:Enjoy a competitive compensation package, including health and wellness benefits, pension plan, paid time off, and more. Career Growth & Development:Take advantage of continuous learning opportunities and stretch assignments. Make an Impact:Play a key role in helping customers navigate challenging situations with empathy and expertise. Inclusive Culture:Work in an environment that embraces diversity, equity, inclusion and belonging. At Heartland Mutual Insurance, you’re empowered to thrive. Whether it’s your career, your well-being, or your future, we've got you covered. #J-18808-Ljbffr