Claims Adjuster
2 months ago
Job Overview
The Claims Adjuster 3, Casualty contributes to Wawanesa's goal of delivering an exceptional and consistent claims experience through proactive and fair investigation, evaluation, negotiation, and settlement of high complexity and large loss casualty claims. This role is responsible for applying and explaining policy coverages and documenting claim files throughout the life of a claim. The role is accountable for providing timely service and prompt management of claims pending from initial report to conclusion.
Key Responsibilities
- Conduct thorough and fair liability, coverage, and quantum investigations to provide the best defense for members.
- Communicate effectively with members, claimants, and other stakeholders through timely and professional voice-to-voice, digital, and written correspondence.
- Adjust casualty claims of high complexity and large loss, ensuring accurate and timely resolution.
- 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, considering relevant information from various sources.
- Conduct comprehensive investigations to determine coverages and liability, adhering to Wawanesa's adjusting guidelines and recognizing when to engage internal and external resources.
- Coordinate and manage services with vendors and service providers, such as lawyers, engineers, accountants, and health practitioners.
- Negotiate with claimants, lawyers, and other insurers to resolve claims at the best possible outcome for members.
- Maintain an effective and current diary system and document claim file activities in accordance with established procedures.
- Demonstrate and maintain knowledge and understanding of policy coverages, complying with regional regulatory and licensing requirements.
- Participate in private mediation, court proceedings, and other dispute resolution as required.
- Contribute to employee development through training, technical guidance, and coaching.
Qualifications
- Exceptional customer service skills, demonstrating empathy and concern for member satisfaction.
- 5 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.
- Excellent knowledge of medical and legal terminology.
- Excellent communication skills, including listening, written, and spoken.
- Excellent investigative and analytical skills, 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.
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