Claims Specialist

1 week ago

Toronto, Canada Munich Re Full time

**Claims Specialist (Group LTD)**:
The Claims Specialist reports to the AVP Claims and manages assigned claims and clients. The role valuates and proactively assists clients in enhancing their claim practices and performs client reviews and supports industry presentations / internal projects.

**Company**
Munich Re
**Location**
Toronto, Canada

**Claim Adjudication**
- Conduct expert claim adjudication within internal standards, delegated authority limits and client response timelines.
- Monitor coverage assessment including promptly identifying, addressing, and resolving coverage matters.
- Proactively investigate and assess claim inconsistencies.
- Promptly approve payments in accordance with payment authorization protocols and client service level agreements.
- Archive all claim documentation in an appropriate and orderly manner; proactively manage claim file follow up process.

**Client Management**
- Establish strongly positive, mutually beneficial, long-term client relationships through professional and knowledgeable communication.
- Monitor clients claim results and provide business partners with accurate client information on a timely basis through claim analytics, data mining and trend analysis.
- Assist with identifying/implementing initiatives to enhance claim handling efficiencies and effectiveness.
- Develop and implement strategies to track and improve deteriorating client claim results.

**Risk Monitoring and Claim Reviews**
- Interpret contract language as applicable with a strong understanding of the group insurance market and claim handling best practices.
- Identify and communicate exceptions to reinsurance treaty terms (as needed) and claims where non-compliance exists to internal business partners and provide recommendations for resolution.
- Perform client reviews (audits) according to reinsurance treaty contracts; produce written analytical review reports with sound recommendations.
- Participate in client review result presentations; follow up on recommended client actions to improve client review results.
- Present claims to Senior Management for evaluation/authority including completion of pertinent claim summary reports and notice of high exposure claims.

**Knowledge Transfer**
- Create and deliver presentations and training programs for clients and internal business partners via industry seminaros or internal publications.
- Engage with pricing, underwriting, and legal to ensure treaty and contractual liabilities, product language and client decisions meet Munich Re’s risk standards and intent.

**Project Management**
- Complete claims contributions for product development, treaty/contract wording, industry surveys and publications and special projects as required.

**Qualifications**:

- University degree in health sciences, psychology, criminology, or business or related field.
- LOMA or other insurance designation (NIDMAR, CEBS), or progression towards is highly desired.
- Minimum 2 years insurance claims experience (short
- and long-term disability required, life or critical illness an asset)
- Exhibits thoroughness, accuracy, and attention to detail in claim reviews and data capture.
- Demonstrated desire and aptitude to learn other lines of business and claim types.
- Excellent presentation and report creation and delivery skills.
- Related experience in group insurance, reinsurance, underwriting, medical concepts, or financial analysis will be an asset.
- Bilingual (French) is required.
- Ability for occasional travel across Canada (approximately 5%).

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