Specialist, Accident Benefits Claims

**Specialist, Accident Benefits Claims**:
Job ID : 5914
Category : Claims
Brand : Definity
Regular/Temporary : Regular
Fulltime/Parttime : Full Time
Location : North York, Canada

Definity includes some of Canada’s most long-standing and innovative insurance brands, including Economical Insurance, Sonnet Insurance, Family Insurance Solutions, and Petline Insurance. With strong roots that date back to 1871, we’ve grown to become a digital leader in the insurance industry. We’re proud to help our clients and communities adapt and thrive in a world of constant change.

Our promise to you: It’s better here. Why? Because we CARE, and we provide an employee experience that’s collaborative, ambitious, rewarding, and empowering.

Our ambition is to be one of Canada’s leading and most innovative P&C insurers. Come be a part of our journey, and love what you do.

Starting in September, Definity employees move to a hybrid work model so we can collaborate, build mentoring relationships, and solve complex or cross-functional business opportunities together. Our teams work in whichever environment best supports what they're working on and who they're working with. We're actively reinventing our offices as welcoming workspaces that optimize collaboration and empower leaders to use our space to strengthen team dynamics. Our tools and processes seamlessly connect employees from multiple locations, and our culture encourages respectful engagement and flexibility. Leaders work with their teams to determine the right balance of on-site and remote work that best meets the needs of their team, cross-functional engagement, responsibilities and timelines, plus those of our customers, our broker partners, and the company culture.

Reporting to the Team Leader, Accident Benefits, you are accountable for handling highly complex, severe and contentious Accident Benefit claims in accordance with the Statutory Accident Benefits Schedule.

**Specific Responsibilities**:

- Handling files in good faith and in accordance with legislative requirements
- Handling LAT disputes with and without legal counsel
- Formulating file handling strategies and work plans
- Working with legal counsel
- Conducting settlement analysis
- Participating in Global Mediation and Private Arbitrations
- Providing coaching and support on file handling to Accident Benefit team members.
- Securing details of claims
- Assessing coverage eligibility
- Reserving files appropriately after assessing claim
- Maintaining detailed file records on an electronic claims system
- Processing payments after confirming benefits, eligibility and reserves
- Coordinating the most effective course of action for claims
- Responding to claimant correspondence and Accident Benefit forms in accordance with the applicable legislation
- Reviewing and approving, when appropriate, treatment plans for claimant rehabilitation.
- Arranging insurer examinations to determine benefit eligibility
- Obtaining medical information necessary for insurer examinations
- Responding to assessment recommendations
- Handling complex AB claims including those involving catastrophic injuries
- Other duties as assigned

**Personal Characteristics**:

- Professional, friendly and courteous in all interactions, whether with customers or co-workers.
- Perform well in a busy operation and remain calm under pressure.
- Team player adaptable to a changing environment.
- Strong written and verbal communication skills.

**Qualifications**:

- 5 years of experience handling Accident Benefits claims
- Excellent working knowledge of the Statutory Accident Benefits Schedule.
- Experience coaching others.
- University degree in any discipline **or **a college diploma in related field **or **the CIP designation
- Excellent verbal and written communication skills.

**Go ahead and expect a lot — you deserve it, and we’ve got it**:

- Hybrid work schedule for most roles
- Company share ownership program
- Pension and savings programs, with company-matched RRSP contributions
- Paid volunteer days and company matching on charitable donations
- Educational resources, tuition assistance, and paid time off to study for exams
- Focus on inclusion with employee groups, support for gender affirmation surgery, access to BIPOC counsellors, access to programs for working parents
- Wellness and recognition programs
- Discounts on products and services

**Background checks**
This role requires successful clearance of a background check (including criminal checks and leadership references).

LI-Hybrid