Dispute Resolution Specialist

1 month ago

Regina, Canada Saskatchewan Government Insurance Full time

Do you value integrity and innovation? How about passion and caring? Great Us too, and that's why you'll fit right in. Our intentional culture promotes trust and participation, encouraging you to bring your heart and mind to work every day.

In-Scope

Multiple Positions

Are you an insurance and healthcare expert with a knack for mediation and dispute resolution? Are you ready to stretch your skills in new ways? We may have the opportunity for you

As a Dispute Resolution Specialist, you will be responsible to review, investigate, monitor, and provide timely resolutions to mediations and appeals on injury claim files that are escalated to you. You will provide guidance, problem solving, insight, and expertise to promote the resolution of mediations and appeals. You will educate, direct, and advise Personal Injury Representatives and Legal staff to create an understanding of processes and steps required by the various internal partners working to a claims resolution. This is a key role in identifying and recommending tactics to reach a resolution in the various types of disputes that come up at a provincial level on injury claim files.

KEY ACCOUNTABILITIES:

- Note_:_ This section is not intended to be an exhaustive list of duties and responsibilities - other duties and responsibilities may be assigned._

Dispute Resolution- Represents the interests of the corporation in No Fault Injury claims mediations and appeals, recommends approval and/or denial of coverage/benefits, and prepares claims for mediation, appeal, and/or action by other personnel.- Provides guidance on the preparation of claims files for legal action, further investigation, review by other personnel, and/or denial.- May represent the interests of the company in legal proceedings and/or other judicial, legal institutional, or regulatory bodies.- Considers implications of decisions or recommendations and how they may impact cases or set precedent within the province.- Liaises between SGI, and all current and future external partners involved in the dispute resolution processes at SGI. e.g., mediations and appeals through the commission or the courts.- Leads meetings and/or conducts interviews with SGI personnel, treating practitioners, witnesses, legal representatives, and other external persons as required.- Reviews claim files and/or associated documentation administered by PIR I, PIR II, and Senior PIR, to ensure that claims are proceeding according to established protocols and procedures.- Confirms and/or explains coverages, benefits, breaches of conditions and/or exclusions in accordance with policy wording and applicable legislation and regulations to customers and/or their representatives, brokers, or other parties.

Claims Operations- Provides technical guidance to verify coverage and/or validity of claims, as it relates to appeals and mediation, as determined through interpretation of the AAIA, policy wordings and other related acts and regulations.- Processes and negotiates contentious and/or difficult claims and settlements with customers and/or representatives when required.-
- May conduct workgroup meetings to facilitate technical communication.- Supports project work within Injury Claims.- Represents SGI at town halls and other industry events.

High Performance Team & Culture- Supports a culture of leadership and accountability to effectively meet the key accountabilities within the scope of the role.- Displays leadership by committing to a culture of continuous learning/development of self and supports others by actively sharing knowledge, providing guidance, mentoring, training, and supporting developmental opportunities.- Demonstrates that the Health, Safety and Emergency Management Policy is applied in area of responsibility for self and others.TECHNICAL KNOWLEDGE & SKILLS- Knowledge of the insurance coverages and benefits provided by the Automobile Accident Insurance Act, No Fault Injury Program, and other related legislation, and/or general business policy wordings.- Knowledge and understanding of the terminology and treatments involved in vocational and medical rehabilitation including catastrophic injuries.- Knowledge of the internal and external partner processes and procedures as they relate to case management and the adjudication of No Fault injury claims and the dispute resolution processes.- Knowledge of the organization’s customer service initiatives.

EDUCATION & CERTIFICATIONS- Two-year diploma from an accredited post-secondary education institution in a relevant field of study such as Business, Social Sciences or Heath Sciences, or defined equivalency.

EXPERIENCE- 5 - 7 years’ experience in claims adjusting or dispute resolution interacting with internal/external business partners and at least 3 years of injury claims experience.

BEHAVIOURAL COMPETENCIES

Leader Level 3 - Applies (Team/Dept)- Accountability - Provides Direction and Sets Expectations- Business Acumen - Applies Broader Business Metrics an

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