Claims Adjuster
2 days ago
The Claims Adjuster 3, Casualty plays a pivotal role in Wawanesa's mission to deliver exceptional and consistent claims experiences 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 position 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 internal teams to effectively manage claims and resolve inquiries in a professional manner.
- Adjust casualty claims of high complexity and large loss, applying in-depth knowledge of policy wordings and coverage decisions.
- 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 life of the claim 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, managing claims in litigation, mediation, or arbitration.
- 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, and staying 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.
- 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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