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Insurance Claims Adjuster

1 month ago


Edmonton, Alberta, Canada Wawanesa Insurance Full time

Job Overview

The Claims Adjuster 3, Casualty (CGL Non-Auto) plays a crucial role in 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 claim's lifecycle. The Claims Adjuster 3 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.
  • Ensure timely and proactive communication with members, stakeholders, and vendors through voice-to-voice, digital, and written correspondence.
  • Adjust complex casualty claims, including those involving high-value losses and intricate liability issues.
  • Review and interpret policy wordings to determine policy coverage and communicate coverage decisions to members.
  • Establish timely and accurate loss and expense reserves throughout the claim's lifecycle by evaluating 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. Manage claims in litigation, mediation, or arbitration, providing instruction to assigned counsel.
  • 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 (as applicable). Remain current with legislative changes and trends in the insurance industry.
  • Occasionally 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.
  • 5-10 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 reaching 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.

About Wawanesa Insurance

Wawanesa Insurance is a leading provider of insurance solutions in Canada, recognized for its commitment to delivering exceptional service and value to its customers. As an equal opportunity employer, Wawanesa is dedicated to fostering a diverse and inclusive workforce that reflects the communities it serves.