Claims Adjuster Level 1

2 months ago

Dartmouth, Canada Wawanesa Insurance Full time

**Date**:Oct 21, 2024

**Location**: Dartmouth, NS (Hybrid), CA Moncton, NB (Hybrid), CA

**Company**:Wawanesa Insurance

**Job ID**: 8670

**Working Business Language**: Bilingual in French and English.

**Salary**: At Wawanesa, salary is only one component of a holistic, comprehensive and competitive offering that we provide to our employees. In addition to salary, full-time and part-time permanent employees are eligible for an annual bonus plan, leave of absence top-up programs and provided with generous vacation time, personal days, premium free benefits and pension plan.

**About Us**
At Wawanesa, we’re proud to offer a hybrid work environment that offers flexibility to our employees in balancing in-office (2 days per week OR 15 hours per week in a Wawanesa office) and remote work. You may work from any of the following locations: Moncton, NB; Dartmouth; NS.

We are currently looking for dedicated, driven, and enthusiastic individuals who thrive in an environment that welcomes change and are looking for an opportunity for diverse experience and advancement on a growing team.

**Job Overview**:
**Responsibilities**:

- Provide direction and support to our injured members through throughout the claims process, by providing an exceptional member experience delivered with empathy.
- Timely and proactive communication, through voice to voice, digital and written correspondence, ensuring that all inquiries are effectively dealt with in a timely and professional manner.
- Adjustment of Accident Benefit claims of moderate to high complexity.
- Review and interpret policy wordings, determine policy coverage, and communicate coverage decisions to members.
- Establish timely and accurate loss and expense reserves throughout the life of the claim through evaluation of relevant information from various sources such as medical, legal, financial, and vocational.
- Ensure a comprehensive investigation is conducted on all files to determine coverages and liability, while adhering to Wawanesa’s adjusting guidelines, and recognizing when to engage appropriate internal and external resources.
- Coordinate and manage services with vendors and service providers such as accountants, lawyers, rehabilitation clinics and health practitioners.
- Negotiating and conveying claim settlements within authority limits. Communicating claim decisions promptly and effectively, while still delivering an exceptional member experience. Manage claims in litigation, mediation, or arbitration. Provide instruction to assigned counsel.
- Maintain an effective and current diary system and document claim file activities in accordance with established procedures and Wawanesa's Proactive Case Management Model.
- Demonstrate and maintain knowledge and understanding of policy coverages, while complying with regional regulatory and licensing requirements (as applicable). Remaining current with legislative changes and trends in the insurance industry.
- Liaise with claimants, doctors and rehabilitation specialists Doctors, Lawyers, Employers, Treatment Providers, Case managers, Clinical Resource Team, Return to Work Team, and Injured Members in accordance with Wawanesa's Proactive Case Management approach. Occasionally participate at private mediation, court proceedings and other dispute resolution as required.
- Within a limited role contribute to employee development through training, technical guidance, and coaching.
- Perform other duties as assigned.

**Qualifications**:

- Exceptional customer service skills demonstrating empathy and concern for member satisfaction.
- 2 years of insurance adjusting experience or equivalent.
- Post-secondary degree is preferred.
- Willingness to work toward Chartered Insurance Professional (CIP) designation and where required, dedicated to reach the proper licensing requirements.
- Comprehensive knowledge of medical and legal terminology.
- Excellent communication skills; listening, written, and spoken.
- Excellent investigative and analytical skills. Detail oriented with a high degree of accuracy regarding data entry.
- Excellent time management and organizational skills with the ability to prioritize work in a fast paced, changing environment.
- Excellent negotiation, decision making and critical thinking skills.
- Strong teamwork skills with the ability to collaborate with others.

**Wawanesa is proud to be one of **Manitoba’s Top Employers**, a **Kincentric Best Employer** in Canada and a **Forbes Best Employer** in Canada recognizing an exceptional place to work**

**Diversity Equity, Inclusion & Belonging

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