Adjuster Level II, Accident Benefits Claims

3 days ago

Waterloo, Ontario, Canada Heartland Mutual Insurance Full time

At Heartland Mutual Insurance, we're more than just a company — we're a community.

Proudly rooted in Ontario and Nova Scotia, we're driven by a bold vision: to be the Best Mutual. Our team of passionate professionals doesn't just follow the norm — we challenge it. We think differently, aim high, and deliver on our promise with a personal touch.

Here, you'll be part of a culture that values authenticity, embraces change, and empowers you to make a meaningful impact every day. Together, we bring our purpose to life by living our values and putting people first.

The Adjuster Level II, Accident Benefits Claims, is responsible for managing a range of injury claims under the Statutory Accident Benefits Schedule (SABS) with moderate complexity. This includes handling Minor Injury Guideline (MIG) claims with and without specified benefits and certain non-complex priority disputes. The role supports the development of strong technical skills while also contributing to early investigations of potential fraud and identifying opportunities for priority and loss transfer reviews. This role is designed to bridge foundational and advanced claims handling, offering stretch development files (5–10%) to prepare for Level III responsibilities.

A)  Job Specific Accountabilities - Key Responsibility Areas (KRA's)

 
What you will do...
Injury Claims Handling:
· Independently manage MIG claims, including those with specified benefits such as income replacement, medical, and rehabilitation benefits.
· Handle non-complex priority disputes, providing clear documentation and supporting analysis.
· Ensure timely adjudication of benefits, reserving accuracy, and compliance with SABS timelines.
Stakeholder Communication and File Management:
· Maintain professional and empathetic communication with claimants, medical providers, legal representatives, and internal partners.
· Coordinate assessments, monitor treatment plans, and follow up on insurer examinations and independent evaluations.
· Maintain thorough, accurate file notes and documentation in accordance with regulatory and organizational standards.
Risk Assessment and Escalation:
· Identify potential indicators of fraud and work collaboratively with the Senior Special Investigator as required.
· Escalate files with complexity beyond scope or where annuity settlements or catastrophic impairment assessments are involved.
Interdepartmental and External Collaboration:
· Support junior team members and coordinate with Appraisers, Legal Counsel, and Medical Consultants.
· Communicate effectively with Brokers, Agents, and Direct Sales Center staff to ensure seamless claims experience.
Development and Stretch Assignments:
· Handle 5–10% of stretch files to support development toward Level III responsibilities.
· Participate in training sessions, feedback loops, and quality assurance reviews.
Regulatory Compliance and Technical Contribution:
· Adhere to all applicable legislation, including SABS and privacy requirements.
· Complete Priority and Loss Transfer Reviews in accordance with department expectations.
· Contribute process feedback to help improve operational effectiveness and customer outcomes.
 

What you will bring...

Education & Experience:

  • 2–4 years of Accident Benefits adjusting experience.
  • Post-secondary education in Insurance, Business, or a related field; CIP designation in progress preferred.

Technical Skills & Knowledge:

  • Proficient understanding of the SABS framework, injury claim management, and specified benefits.
  • Familiarity with claims systems, insurer assessments, and medical provider protocols.

Competencies:

  • Analytical thinking and confident decision-making.
  • Excellent interpersonal, organizational, and time management skills.
  • Professionalism, discretion, and ability to manage sensitive, confidential information.
  • A strong commitment to continuous learning, collaboration, and customer service excellence.

If you have the qualifications we are seeking and would thrive in a work environment where you are valued and respected, please apply on the company website. Accommodation is available on request for candidates taking part in all aspects of the selection process.

What's in it for You:

  • Join a Supportive Team: Be part of a collaborative and high-performing team that values knowledge sharing and celebrating wins together.
  • Comprehensive Total Rewards: Enjoy a competitive compensation package, including health and wellness benefits, pension plan, paid time off, and more.
  • Career Growth & Development: Take advantage of continuous learning opportunities and stretch assignments.
  • Make an Impact: Play a key role in helping customers navigate challenging situations with empathy and expertise.
  • Inclusive Culture: Work in an environment that embraces diversity, equity, inclusion and belonging.

At Heartland Mutual Insurance, you're empowered to thrive. Whether it's your career, your well-being, or your future, we've got you covered.

This job posting is for an existing vacancy within Heartland.

We do not use artificial intelligence or automated decision-making tools in any part of our hiring process. All applications are reviewed by our Talent Acquisition team to ensure a fair and transparent process.

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