Claims Specialist

2 months ago


Edmonton, Alberta, Canada Peace Hills Insurance Full time

We are seeking a highly skilled Claims Advisor to join our team at Peace Hills Insurance. As a Claims Advisor, you will play a critical role in handling both Automobile and Accident Benefits claims, ensuring that our clients receive the best possible service.

Key Responsibilities:

  • Verify and explain coverage to clients, ensuring they understand their policy and how it applies to reported claims.
  • Investigate, evaluate, negotiate, and settle total loss claims, determining liability and ensuring fair outcomes.
  • Explain the claims process to clients, providing clear and concise information on both automobile and accident benefits.
  • Obtain recorded statements, collect and review medical documents, and verify employment information.
  • Calculate benefit entitlements, authorize treatment, and arrange billing with clients or providers.
  • Correspond with doctors, lawyers, treatment providers, employers, and clients, ensuring seamless communication.
  • Identify questionable claims, request and arrange MSE's, IME's, and IDE's, and arrange treatment at specialized facilities.
  • Document activity on the file, issue payments on a timely basis, and liaise with Brokers and Underwriters.

Requirements:

  • Minimum of 3+ years of adjusting experience in a similar role, with at least 1 year of Accident Benefits experience preferred.
  • Post-secondary diploma or degree, and/or working towards a CIP/FCIP designation, would be considered an asset.
  • Ability to negotiate and critically analyze data, with strong decision-making skills.
  • Familiarity with auto contract and laws applicable to Accident Benefits coverage, as well as medical terminology and abbreviations.
  • Awareness of common types of traumas, their treatments, and recovery periods, and knowledge of human anatomy and physiology.
  • Highly developed interpersonal, organizational, and time management skills, with strong written and verbal communication skills.

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