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Junior, Intermediate OR Senior level will be hired based on the skills the successful candidate(s) brings to the position.
This position will be located in the branch nearest to the successful applicant in either Ottawa, Hamilton, Toronto, Kitchener-Waterloo, or London.
Reporting to the Team Leader, Accident Benefit Claims, you are accountable for investigating, evaluating and settling Accident Benefit claims in accordance with the Insurance Act and the Statutory Accident Benefits Schedule.
Specific Responsibilities:
- Securing details of claims by corresponding with claimants in person and via telephone.
- Assessing coverage eligibility.
- Applying applicable Priority Rules chart to each claim file.
- Processing election of benefit claims.
- 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 independent medical assessment to determine benefits eligibility.
- Preparing referral packages for independent medical assessments.
- Obtaining medical information necessary for independent medical assessments.
- Responding to independent medical assessment recommendations.
- 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:
- University degree in any discipline or a college diploma or the CIP designation.
- Preference will be given to candidates with prior claims handling experience.
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