Sr Representative, Accidents Benefits Claims

The Opportunity

This opportunity is well suited for an experienced Accident Benefits professional who thrives in a fast-paced environment and is committed to delivering exceptional customer service. Reporting to the Team Leader, Accident Benefit Claims, you will be responsible for managing a diverse and complex portfolio of claims, including income replacement, non-earner, caregiver, permanent impairment, and fatality benefits. Working closely with customers, healthcare practitioners, and other stakeholders, you will assess coverage eligibility, facilitate rehabilitation and recovery, and ensure claims are administered fairly, accurately, and in compliance with the Insurance Act and Care First principles.

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 practitioners, 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 out of province and election of benefit claims
• Processing income replacement, non-earner, loss of studies, caregiver, permanent impairment, fatality, and other 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 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

• University degree in any discipline or a college diploma or the CIP designation
• Minimum of 4 years Claims handling experience
• Computer proficient in MS Word and Excel
• 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: $59,300 - $109,200