Claims Specialist

2 months ago

Toronto, Ontario, Canada Munich Re Full time
Job Title: Claims Specialist

We are seeking a highly skilled Claims Specialist to join our team at Munich Re. As a Claims Specialist, you will play a critical role in managing assigned claims and clients effectively and efficiently.

Key Responsibilities:
  • Conduct expert claim adjudication within internal standards, delegated authority limits, and client response timelines.
  • Monitor coverage assessment, including promptly identifying, addressing, and resolving coverage matters.
  • Proactively investigate and assess claim inconsistencies.
  • Promptly approve payments in accordance with payment authorization protocols and client service level agreements.
  • Archive all claim documentation in an appropriate and orderly manner; proactively manage claim file follow-up process.
Client Management:
  • Establish strongly positive, mutually beneficial, long-term client relationships through professional and knowledgeable communication.
  • Monitor clients' claim results and provide business partners with accurate client information on a timely basis through claim analytics, data mining, and trend analysis.
  • Assist with identifying and implementing initiatives to enhance claim handling efficiencies and effectiveness.
  • Develop and implement strategies to track and improve deteriorating client claim results.
Risk Monitoring and Claim Reviews:
  • Interpret contract language as applicable with a strong understanding of the group insurance market and claim handling best practices.
  • Identify and communicate exceptions to reinsurance treaty terms (as needed) and claims where non-compliance exists to internal business partners and provide recommendations for resolution.
  • Perform client reviews (audits) according to reinsurance treaty contracts; produce written analytical review reports with sound recommendations.
  • Participate in client review result presentations; follow up on recommended client actions to improve client review results.
  • Present claims to Senior Management for evaluation/authority, including completion of pertinent claim summary reports and notice of high exposure claims.
Knowledge Transfer:
  • Create and deliver presentations and training programs for clients and internal business partners, via industry seminars or internal publications.
  • Deliver leading-edge knowledge of insurance claim investigations and practices to clients and internally. Apply emerging risk management knowledge to client claim situations and share expertise throughout the Munich Reinsurance Group, e.g., product development, contract wording.
  • Engage with pricing, underwriting, and legal to ensure treaty and contractual liabilities, product language, and client decisions meet Munich Re's risk standards and intent.
Project Management:
  • Complete claims contributions for product development, treaty/contract wording, industry surveys, and publications and special projects as required.
Qualifications:
  • University degree in health sciences, psychology, criminology, or business or related field.
  • LOMA or other insurance designation (NIDMAR, CEBS), or progression towards is highly desired.
  • Minimum 2 years insurance claims experience (short- and long-term disability required, health or dental an asset).
  • Exhibits thoroughness, accuracy, and attention to detail in claim reviews and data capture.
  • Strong analytical and inquisitive skills; excellent attention to meeting time service and achieving deliverables.
  • High degree of self-motivation, continuing development, and proven ability to work independently.
  • Demonstrated desire and aptitude to learn other lines of business and claim types.
  • Excellent presentation and report creation and delivery skills.
  • Strong oral and written communication skills.
  • Demonstrated ability to build solid client relationships.
  • Related experience in group insurance, reinsurance, underwriting, medical concepts, or financial analysis will be an asset.
  • Bilingual (French) is required.
  • Willingness to travel across Canada, minimal travel expected.
About Munich Re:

We are a leading reinsurance company with more than 40,000 employees in over 50 locations around the globe. We recognize Diversity, Inclusion, and Belonging as a key priority with a culture that welcomes different thoughts and opinions. We dare to think big and are continuously innovating on behalf of our clients.

We offer a work environment that promotes professional development, innovation, and rewards high performance. We are committed to providing a work environment that is inclusive and free of employment barriers and discrimination. Accommodations will be made for qualified applicants with a disability throughout the recruitment process.

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