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Richmond Hill

    Specialist, Claims Accident Benefits - North York, Canada - Definity Careers

    Definity Careers
    Definity Careers North York, Canada

    3 weeks ago

    Default job background
    Full time
    Description

    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
    • Applying applicable Priority Rules chart to each claim file
    • 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.

    Salary range is $54,800 - $100,800

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