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Claims Examiner

1 month ago

Toronto, Canada Zurich Insurance Full time

Job SummaryZurich Insurance is a global insurance company with a specialty in life insurance, general insurance and travel insurance. This role will sit in one of Zurich’s subsidiary companies, World Travel Protection, which focuses on providing travel risk management and emergency assistance support.

World Travel Protection (WTP) is a leading travel assistance and Travel Risk Management (TRM), company. WTP provides robust response solutions to logístical, security and medical emergencies for travellers based on its global reach and through its worldwide provider network. Through this network, WTP is able to effectively resolve incidents inherent to international traveling. Prevention is also at the forefront of WTP through a wide range of risks mitigation and security assistance solutions available to its clients to ensure that their resources are best utilised to anticipate crisis from occurring.
- **Grow your Claims career**:

- **Join a team that really cares about our customers**:

- **Enjoy a culture focused on results, allowing flexibility on when and where you work**

World Travel Protection provides global travellers with specialist emergency assistance services when something goes wrong in their travels. We operate 24 hours a day, seven days a week from our operation centres in Australia, Canada, the United Kingdom, and Malaysia, responding to the cries for help we receive from travellers across the globe.

Owned by Zurich, but with separately managed business entities, we can truly offer you a world of possibilities within assistance and insurance. Get ready to do your best work and then some.

The World Travel Protection Claims Examiner plays a vital role in investigating, evaluating and concluding low exposure, low complexity travel insurance claims by following established protocols to ensure that claims are handled in the most effective, efficient way while delivering a customer-centric claims service.
- A bit about the job:
- Capture and update claims data/information in compliance with best practices for low complexity, low exposure personal or commercial line claims.- Determine liability by gathering relevant facts, utilizing applicable law and establishing basic principles of negligence.
- Confirm policy existence by identifying coverage on low complexity claims.
- Work to have a timely resolution to claims by developing case strategy, developing a case evaluation, escalating issues as appropriate and providing status updates to ensure customer satisfaction.
- Establish timely reserves within authority limit by estimating value of claims.
- Assess damages by calculating applicable damages or range of damages allowed by law.
- Ensure customer service by proactively communicating information, responding to inquiries and following customer protocols.
- Manage expenses by working within vendor approved networks and managing scope of work assigned to outside contractors. Depart from approved vendors with manager approval, where in the best interests of the insured.
- Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
- Refer claim to subrogation and fraud teams by identifying potential subrogation and fraud.
- Protect Zurich's reputation by keeping claims information confidential.
- Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks and participating in professional societies.
- Contribute to the team effort by accomplishing related results and participating on projects as needed.
- Follow established claims handling procedures for low complexity, low exposure personal or commercial line claims to ensure consistency and quality in claims services.
- Collect data and document in established system to facilitate the accurate assessment and value of claims.
- Input relevant data into established systems accurately so that analysis can be undertaken.
- Identify and resolve problems by referring to policies, procedures, and standards to ensure consistency and quality of solutions.
- Assess and appoint claims vendors within agreed authority limits aligned to the organization´s Claims Vendor Management strategy.
- Determine when to solicit input from more senior colleagues or managers for more complex issues, to ensure quality and promote continuous learning.
- Provide feedback on business processes and systems to identify opportunities for improvements.
- A bit about you:
- Required:
- Bachelors Degree and no prior years of experience required in the Claims Administration area.

OR- High School Diploma or Equivalent and 1 - 2 years of experience in Claims area.

OR- Zurich Certified Insurance Apprentice including an Associate Degree, and no prior years of experience in the Claims area.

AND- Microsoft Office experience
- Claims experience

Preferred:
- 2 years experience in Claims adjudication
- Analytical skills
- Prioritizat