Specialist, Accident Benefits Claims

The Opportunity

This role is suited for a highly experienced Accident Benefits professional with strong technical expertise in complex claims management and dispute resolution. Reporting to the Team Leader, Accident Benefit Claims, you will manage a portfolio of complex claims, including catastrophic injuries, permanent impairment, and fatality benefits, while ensuring compliance with the Insurance Act and the organization's Care First principles. In addition to providing exceptional service to customers and stakeholders, you will collaborate closely with legal counsel, develop strategic file handling plans, and serve as a mentor and resource to team members by providing coaching and guidance on complex claims matters.

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 providers, and/or representatives
• Regular communication with the customer and their health care practitioner(s)
• Handling complex Accident Benefits claims including those involving catastrophic injuries and permanent impairment
• Processing income replacement, non-earner, loss of studies, caregiver, fatality, and other benefits
• Handling ACT disputes with and without legal counsel
• Formulating file handling strategies and work plans
• Working with legal counsel
• Providing coaching and support on file handling to Accident Benefit team members.
• 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
• 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 customer correspondence and forms in accordance with the applicable legislation
• Reviewing and approving, when appropriate, treatment plans for customer rehabilitation.
• Arranging medical assessments as necessary and reviewing and relaying recommendations
• Other duties as assigned

What You Bring

• 5 years of experience handling Accident Benefits claims
• Experience handling Accident Benefits in British Columbia, Saskatchewan, Manitoba, Ontario, or experience with WCB/WSIB/WorkSafe BC, etc. or experience with other long-term disability benefit administration
• 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
• 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.

Salary Range: $73,500 - $123,500