Int Representative, Accident Benefits Claims

The Opportunity

This role is ideal for a customer-focused claims professional who is passionate about supporting individuals through the accident benefits claims process. Reporting to the Team Leader, Accident Benefit Claims, you will be responsible for investigating and adjudicating claims, determining benefit entitlement, and delivering exceptional service in accordance with the Insurance Act and the organization's Care First principles. The successful candidate will work closely with customers, healthcare practitioners, and other stakeholders to coordinate treatment plans, manage claim files, and ensure timely, fair, and accurate claim resolution.

What to Expect

• Report to the Team Leader, Accident Benefit Claims, while investigating, evaluating benefits, and administering the principles of Care First in accordance with the Insurance Act
• Securing details of claims by corresponding with customers, care practitioner(s), and/or representatives
• Regular communication with the customer and their health care practitioner(s)
• Assessing coverage eligibility and reviewing and applying interpretations of policy wordings in the resolution of coverage issues 
• Applying applicable Priority Rules chart to each claim file
• Processing income replacement benefits
• 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
• Confirming collateral benefits
• Responding to customer correspondence and forms in accordance with the applicable legislation
• Reviewing Programs of Care treatment plans for customer rehabilitation and other treatments and benefits as appropriate
• Arranging medical assessments as necessary and reviewing and relaying recommendations
• Other duties as assigned

What You Bring

• University degree, college diploma in related field or the CIP designation
• Minimum 2-3 years of claims handling experience
• Proficient in MS Word and Excel
• Professional, friendly and courteous in all interactions, whether with customers or co-workers
• Able to perform well in a busy operation and remain calm under pressure
• Team player adaptable to a changing environment
• Strong written and verbal communication skills

Salary Range: $51,300 - $94,400