Complex Claims Examiner

3 weeks ago

Waterloo, Ontario, Canada OTIP RAEO Full time

Job Title: Senior Bodily Injury Examiner

Job Summary:

The Senior Bodily Injury Examiner is responsible for investigating, quantifying, analyzing, adjusting, and settling complex property and casualty claims exceeding $250,000. This role focuses on providing quality and customer service by assessing and assigning the appropriate expert and vendor to each claim. The adjustment will be conducted efficiently and effectively to control indemnity, spend, and expenses without compromising superior customer service.

Key Responsibilities:

  • Deliver a superior customer experience by responding to general inquiries, initiating and maintaining contact with insured members, and assisting with commodity claims overflow.
  • Confirm coverage for incoming claims by reviewing and compiling facts, obtaining technical reports from various parties, investigating questionable claims, studying case law for liability and benefit determination, completing contractual coverage analysis, assessing quantum, reviewing subrogation opportunities, negotiating, and resolving severity casualty matters.
  • Maintain quality service and adhere to organizational standards while handling all aspects of file management, including reserving, expense, and loss control, liability assessments, and creating defined disposition plans for future handling leading to file closure.
  • Control and direct work performed by outside experts, medical practitioners, lawyers, and service providers to completion.
  • Represent stakeholders in a professional manner at meetings, court hearings, mediations, and other information gatherings forums with a view of resolution and/or settlement when appropriate.
  • Maintain confidentiality of claims information at all times to protect operations and insured members.
  • Responsible for data integrity, issuance of payments to vendors, insureds, and experts, and maintaining well-organized claim files while ensuring accuracy of data input.
  • Adhere to partner's guidelines, contracts, and insurance regulations to ensure legal and regulatory compliance.
  • Actively participate in coaching and training sessions and collaborate with team members and management.

Requirements:

  • A post-secondary education and/or college diploma within a related field.
  • CIP designation.
  • Ability to hold an adjuster's license.
  • Thorough knowledge of the property and casualty industry.
  • 7-10 years of experience in casualty claims handling, including litigation file management.
  • Experience in handling losses exceeding $250,000.
  • Strong residential construction experience.
  • Knowledge of medical rehabilitation concepts and medical.
  • Case law knowledge.
  • Superior investigation and negotiations skills.
  • Excellent communication skills, verbal and written, to effectively work with internal and external stakeholders.
  • Superior organizational skills to manage competing priorities, including project management skills.
  • Current Microsoft Office working knowledge.
  • Ability to learn and adapt in a fast-paced environment, including working with various computer programs, databases, and software.
  • Ability to work independently and as part of a collaborative team environment.
  • The ability to communicate in French is an asset.

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