Complex Claims Handler

5 days ago


Waterloo, Ontario, Canada Definity Financial Corporation Full time
Definity Financial Corporation is seeking a highly skilled Accident Benefits Specialist to join our team. As an experienced claims professional, you will be responsible for handling complex and contentious Accident Benefit claims in accordance with the Statutory Accident Benefits Schedule.

The ideal candidate will have 7-10 years of experience handling Accident Benefits claims and possess excellent working knowledge of the Statutory Accident Benefits Schedule. You will be expected to provide coaching and support on file handling to Accident Benefit team members, formulate file handling strategies and work plans, and conduct settlement analysis.

This is a challenging and rewarding role that requires a high level of expertise and attention to detail. You will be working with a dynamic team that is dedicated to providing exceptional service to our customers. If you are a motivated and results-driven individual who is passionate about delivering high-quality results, we encourage you to apply for this exciting opportunity.

Key Responsibilities:
  • Handling files in good faith and in accordance with legislative requirements
  • Handling LAT disputes with and without legal counsel
  • Formulating file handling strategies and work plans
  • Working with legal counsel
  • Conducting settlement analysis
  • Participating in Global Mediation and Private Arbitrations
  • Providing coaching and support on file handling to Accident Benefit team members
  • Securing details of claims
  • Assessing coverage eligibility
  • Applying applicable Priority Rules chart to each claim file
  • Maintaining detailed file records on an electronic claims system
  • Processing payments after confirming benefits, eligibility and reserves
  • Coordinating the most effective course of action for claims
  • Responding to claimant correspondence and Accident Benefit forms in accordance with the applicable legislation
  • Reviewing and approving, when appropriate, treatment plans for claimant rehabilitation
  • Arranging insurer examinations to determine benefit eligibility
  • Obtaining medical information necessary for insurer examinations
  • Responding to assessment recommendations
  • Handling complex AB claims including those involving catastrophic injuries

Requirements:

To be successful in this role, you will need to possess the following qualifications and characteristics:
  • 7-10 years of experience handling Accident Benefits claims
  • Excellent working knowledge of the Statutory Accident Benefits Schedule
  • Experience coaching others
  • University degree in any discipline or a college diploma in a related field or the CIP designation
  • Excellent verbal and written communication skills


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