Accident Benefits Claims Specialist

3 weeks ago

Edmonton, Alberta, Canada Peace Hills Insurance Full time

We are seeking a dedicated Claims Advisor specializing in Accident Benefits to join our team at Peace Hills Insurance. This position reports directly to the Claims Manager and is responsible for managing both Automobile and Accident Benefits claims.

Key Responsibilities:

  • Assessing and clarifying coverage details and their relevance to reported claims.
  • Conducting thorough investigations, evaluations, negotiations, and settlements for total loss claims.
  • Determining liability in various cases.
  • Providing clients with a clear understanding of the claims process for both automobile and accident benefits.
  • Collecting recorded statements from involved parties.
  • Gathering and reviewing medical documentation and treatment plans.
  • Verifying employment details as necessary.
  • Calculating entitlements to benefits accurately.
  • Authorizing necessary treatments and coordinating billing with clients or service providers.
  • Maintaining communication with medical professionals, legal representatives, treatment providers, employers, and clients.
  • Identifying and flagging questionable claims.
  • Coordinating and arranging for Medical Specialty Evaluations (MSE's), Independent Medical Evaluations (IME's), and Independent Disability Evaluations (IDE's).
  • Facilitating treatment arrangements at specialized facilities.
  • Documenting all activities related to claims and ensuring timely payment issuance.
  • Collaborating with Brokers and Underwriters.
  • Performing various other duties as required.

Qualifications:

  • A minimum of 3 years of experience in claims adjusting, with at least 1 year focused on Accident Benefits preferred.
  • A post-secondary diploma or degree, or progress towards a CIP/FCIP designation is considered an asset.
  • Strong negotiation skills and the ability to analyze data critically.
  • Familiarity with auto insurance contracts and laws relevant to Accident Benefits.
  • Understanding of medical terminology and abbreviations.
  • Knowledge of common trauma types, their treatments, and recovery timelines.
  • Familiarity with human anatomy and the psychological impacts of trauma is advantageous.
  • Exceptional interpersonal, organizational, and time management skills.
  • Strong written and verbal communication abilities.

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