Insurance Claims Specialist

2 days ago

Toronto, Ontario, Canada Healthcare Insurance Reciprocal of Canada (HIROC) Full time

About HIROC

Healthcare Insurance Reciprocal of Canada (HIROC) is a trusted partner for healthcare organizations, providing innovative insurance, risk management, and claims solutions. With over 700+ member organizations, HIROC offers a comprehensive range of products and support to enhance safety and quality in the Canadian healthcare system.

Career Opportunity

We are seeking an experienced Insurance Claims Specialist to join our team. As a key member of our claims department, you will play a critical role in reviewing initial documentation, applying legal/claims analysis, and making informed decisions to settle or defend claims.

Key Responsibilities

  • Claims Analysis and Review: Conduct thorough reviews of initial documentation, apply legal/claims analysis, and set/amend reserves as necessary.
  • Communication and Negotiation: Instruct adjusters/lawyers on a continuing basis, settle/deny/defend decisions, and conduct negotiations with plaintiff counsel, mediators, pre-trial judges, and claimants.
  • Information Collection and Preservation: Ensure required information/evidence is collected and preserved, authorize mediation & pre-trial expenses, and maintain accurate records.
  • Settlement Decisions and Payments: Make settlement decisions up to the posted reserve of assigned claims, authorize settlement payments, and handle special-focus-area of specialty claims as assigned.
  • Policy Interpretation and Risk Management: Provide advice regarding general risk management queries and/or referral to Healthcare Risk Management department, and work with departments to develop coordinated responses to situations.

Requirements

  • Minimum 8 Years of Experience: Possess a minimum of 8 years of working experience with claims processing activity or equivalent responsibility.
  • CIP/FCIP Courses: Enrollment in or completion of CIP/FCIP required courses.
  • Strong Analytical and Communication Skills: Demonstrate high regard for quality, attention to detail, and ability to maintain confidentiality, along with excellent verbal, written, and oral communication skills.
  • Ability to Work Independently and Collaboratively: Showcase ability to work both independently and as a team member, with flexibility in approach and enthusiasm for creating a safe healthcare system.

Compensation and Benefits

Our salary for this position is estimated at $85,000 - $110,000 per year, depending on experience. We also offer a hybrid work model, opportunities for professional development, and a collaborative work environment that values diversity, equity, and inclusion. If you are passionate about creating a safer healthcare system and have the necessary skills and experience, we encourage you to apply.

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