FOR A VERY LARGE INSURANCE COMPANY
All those who are interested in this opportunity, please send your resume to
jw@no-spam
Functional Contribution: Responsible for the adjustment of claims, including
large and/or very complex Ontario Accident Benefit Claims. Reviews and
investigates claims, including large and/or very complex claims. Analyses
claims' material presented and negotiates claim settlements. Complies with
company policies, procedures and standards while controlling severities and
expenses.
Relationships: Explains information, investigates and negotiates large
and/or very complex claims. Responds to inquiries and complaints. Contacts
include policyholders, claimants, brokers and other insurers. May oversee
the investigation and negotiation of claims for a small team. Represents the
company at settlement meetings requiring strong interpersonal skills.
Discusses information related to large and/or very complex claims,
negotiates vendor fees and investigates the assessment of damage. Provides
recommendations into preferred vendor selection and negotiates fee guides
with vendors within established limits. Exchanges information on specific
claims with independent adjusters and counsel. Maintains internal
relationships with other departments within the company to keep them current
on specific policyholder issues, emerging trends in claims management and to
resolve contentious and often-difficult claims.
Problem Solving/Analysis: Utilizes innovative thinking in the conduct of
investigations and in the development of solutions to large and/or very
complex claims. May establish precedent in dealing with somewhat obscure
claims situations. Searches for solutions to very complex problems outside
of established practice.
Decision Making/Autonomy: Claim file settlement authority up to a maximum of
$100,000. May direct staff resources. Makes very complex interpretive and
application decisions with respect to policies and procedures in their area
of claims expertise. Investigates and recommends amendments to polices and
procedures in their specialty area of claims. Approves invoices from
suppliers and contractors within the company established discretionary
limits for this level.
Leadership/Professional Development: Maintains and continually keeps abreast
of legislation affecting the adjudication of claims in a specialty area.
Maintains a broad appreciation of business objectives with the claims
function in a specialty area. Maintains an expert level knowledge of company
and industry claims adjudication policies, procedures and standards within a
specialized area of claims. In collaboration with the supervisor, identifies
training and development needs.
IDEAL QUALIFICATIONS:
Post Secondary education or equivalent training & experience
CIP courses C11, C12, C13, C14, C17, C32; FCIP course 971; Rehabilitation
Certificate
Eight years Claims' experience, five of which in the direct adjustment of
Ontario Accident Benefit Claims
