Claims Adjuster 2

4 weeks ago

Toronto, Ontario, Canada Wawanesa Insurance Full time
Job Overview

The Claims Adjuster 2 - Casualty Claims Specialist plays a crucial role in delivering an exceptional claims experience by conducting thorough and fair investigations, evaluations, negotiations, and settlements of moderate to high casualty claims. This role is responsible for applying and explaining policy coverages, documenting claim files, and providing timely service and prompt management of claims from initial report to conclusion.

Key Responsibilities
  1. Conduct proactive, fair, and thorough liability, coverage, and quantum investigations to provide the best defense for members.
  2. Communicate effectively with members, stakeholders, and internal teams through timely and professional voice-to-voice, digital, and written correspondence.
  3. Adjust casualty claims of moderate to high complexity, ensuring accurate and timely resolution.
  4. Review and interpret policy wordings, determine policy coverage, and communicate coverage decisions to members.
  5. Establish timely and accurate loss and expense reserves throughout the claim's life cycle, evaluating relevant information from various sources.
  6. Conduct comprehensive investigations to determine coverages and liability, adhering to Wawanesa's adjusting guidelines and engaging internal and external resources as needed.
  7. Coordinate and manage services with vendors and service providers, such as lawyers, engineers, accountants, and health practitioners.
  8. Negotiate with claimants, lawyers, and other insurers to resolve claims at the best possible outcome for members, managing claims in litigation, mediation, or arbitration.
  9. Maintain an effective diary system and document claim file activities in accordance with established procedures.
  10. Demonstrate and maintain knowledge and understanding of policy coverages, complying with regional regulatory and licensing requirements, and staying current with legislative changes and industry trends.
  11. Occasionally participate in private mediation, court proceedings, and other dispute resolution processes as required.
  12. Contribute to employee development through training, technical guidance, and coaching, and perform other duties as assigned.
Qualifications
  1. 2 years of insurance adjusting experience or equivalent, with knowledge of Commercial General Liability and General Liability Claims.
  2. Exceptional customer service skills, demonstrating empathy and concern for member satisfaction.
  3. Post-secondary degree is preferred.
  4. Willingness to work toward Chartered Insurance Professional (CIP) designation and meet licensing requirements where necessary.
  5. Comprehensive knowledge of medical and legal terminology.
  6. Excellent communication, investigative, and analytical skills, with a high degree of accuracy in data entry.
  7. Excellent time management and organizational skills, with the ability to prioritize work in a fast-paced environment.
  8. Excellent negotiation, decision-making, and critical thinking skills.
  9. Strong teamwork skills, with the ability to collaborate with others.

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