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Claims Examiner for Creditor Life and Disability

2 months ago

Burlington, Ontario, Canada Co-operators Full time

About Co-operators

Co-operators is a leading Canadian financial services co-operative dedicated to building a sustainable and resilient society. We prioritize our people, fostering a strong culture and development opportunities that empower our team to thrive and live our purpose.

Our Creditor Team

Our national Creditor team strives to develop and deliver market-leading products and solutions that exceed client expectations. We operate with high integrity, driven by a commitment to doing the right thing for our clients and their members.

The Opportunity: Claims Examiner III, Creditor Life and Disability

As a Claims Examiner III, you will adjudicate and manage a caseload of creditor Group Mortgage Protection (GMP) and Monthly Premium over $50,000 (MP) disability and life claims. This role also encompasses adjudicating and managing claims for other creditor disability products, including Loss of Employment (LOE), and where combined coverage exists, Single Premium (SP), Monthly Premium (MP), and Credit Card.

You will assess eligibility for disability and life benefits, develop case management plans, initiate and implement interventions to minimize claim durations, and authorize and issue disability benefits.

Your Impact:
  • Review current and historical medical information to determine if a material misrepresentation (including fraudulent misrepresentation) has been made by the policyholder during the insurance application process.
  • Communicate rescission decisions to relevant parties, including the policyholder, for policies rescinded due to misrepresentation.
  • Ensure accuracy and completeness of all information received in support of a new claim.
  • Conduct interviews with claimants, employers, and loan officers via telephone prior to making claim decisions.
  • Based on the information gathered, available resources, and policy provisions, determine if a claim is payable.
  • Develop and execute proactive case management plans for each claim, aiming to minimize the disability period.
  • Initiate assessments and examinations as necessary.
  • Proactively assess and review claims for change of definition, including identifying alternative occupations and communicating change of definition decisions.
Your Success:
  • You adapt to change and are committed to continuous improvement to exceed client expectations.
  • Your strong communication skills enable you to convey messages clearly and effectively.
  • You are an effective team player who shares knowledge to support your peers.