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Casualty Claims Specialist
3 months ago
Job Overview
The Casualty Claims Specialist at Wawanesa Insurance plays a vital role in achieving our mission of providing an outstanding and uniform claims experience. This position involves thorough and equitable investigation, assessment, negotiation, and resolution of moderate to high complexity casualty claims. The specialist is tasked with interpreting and clarifying policy coverages while meticulously documenting claim files throughout the claim's lifecycle. The role emphasizes delivering prompt service and efficient management of claims from initial report to final resolution.
Key Responsibilities
- Deliver exceptional advocacy for members through diligent, fair, and comprehensive investigations into liability, coverage, and damages.
- Ensure timely and proactive communication through various channels, including voice, digital, and written correspondence, addressing all inquiries professionally and efficiently.
- Manage casualty claims that present moderate to high complexity.
- Analyze and interpret policy language, ascertain coverage, and effectively communicate coverage determinations to members.
- Establish and maintain accurate loss and expense reserves throughout the claim process by evaluating pertinent information from diverse sources, including independent adjusters, medical professionals, legal advisors, and financial experts.
- Conduct thorough investigations on all claims to ascertain coverages and liabilities, adhering to Wawanesa's adjusting protocols, and recognizing when to involve appropriate internal and external resources.
- Coordinate and oversee services with vendors and service providers, including legal counsel, engineers, accountants, and healthcare professionals.
- Engage in negotiations with claimants, attorneys, and other insurers to achieve optimal resolutions for our members. Manage claims that are in litigation, mediation, or arbitration, providing guidance to assigned legal representatives.
- Maintain an organized and current diary system, documenting all claim file activities in accordance with established protocols.
- Demonstrate a comprehensive understanding of policy coverages while adhering to regional regulatory and licensing standards. Stay informed on legislative changes and trends within the insurance sector.
- Occasionally participate in private mediations, court proceedings, and other forms of dispute resolution as necessary.
- Contribute to employee development through training, technical support, and mentoring within a limited capacity.
- Perform additional duties as assigned.
Qualifications
- Outstanding customer service abilities, showcasing empathy and commitment to member satisfaction.
- Minimum of 2 years of experience in insurance adjusting or a related field.
- A post-secondary degree is preferred.
- Commitment to pursuing the Chartered Insurance Professional (CIP) designation and, where applicable, dedication to fulfilling licensing requirements.
- In-depth knowledge of medical and legal terminology.
- Exceptional communication skills, both written and verbal, with strong listening abilities.
- Excellent investigative and analytical capabilities, with meticulous attention to detail in data entry.
- Strong time management and organizational skills, with the ability to prioritize tasks in a dynamic environment.
- Proficient negotiation, decision-making, and critical thinking skills.
- Strong collaborative skills, with the ability to work effectively within a team.
Diversity, Equity & Inclusion
Wawanesa is an equal opportunity employer committed to fostering a diverse workforce that is equitable and inclusive for all. We provide equal employment opportunities to all employees and applicants without regard to any individual's protected status. Accommodations related to disability or medical needs are available upon request throughout all stages of the recruitment and selection process.
