Intermediate Representative, Accident Benefit Investigations Claims
Job ID : 6864
Category : Claims
Brand : Definity
Regular/Temporary : Regular
Fulltime/Parttime : Full Time
Location : Toronto, Canada
Definity includes some of Canada’s most long-standing and innovative insurance brands, including Economical Insurance, Sonnet Insurance, Family Insurance Solutions, and Petline Insurance. With strong roots that date back to 1871, we’ve grown to become a digital leader in the insurance industry. We’re proud to help our clients and communities adapt and thrive in a world of constant change.
Our promise to you: It’s better here. Why? Because we CARE, and we provide an employee experience that’s collaborative, ambitious, rewarding, and empowering.
Our ambition is to be one of Canada’s leading and most innovative P&C insurers. Come be a part of our journey, and love what you do.
Definity offers a flexible, hybrid work experience where employees work from the office and virtually depending on the type of work they are doing and who they are working with. Leaders partner with their teams to find the right balance of on-site and remote work that best meets the needs of their teams, colleagues, brokers and customers, while ensuring collaboration, teamwork and accountability for goals.
Reporting to the Team Leader, Accident Benefit Claims, you are accountable for investigating, evaluating and settling Accident Benefit claims in accordance with the Insurance Act and the Statutory Accident Benefits Schedule.
- Investigation is key: you will be collaborating with the National SIU Investigations Team to develop investigation strategies on files.
- You will complete detailed investigations of accident benefits claims where fraud indicators are detected
- You will be assessing coverage eligibility and reviewing and applying interpretations of policy wordings in the resolution of coverage issues
- Coordinating the most effective course of action for claims investigations and SABS compliance
- Securing details of claims by corresponding with claimants and/or representatives
- Applying applicable Priority Rules chart to each claim file
- Processing election of benefit claims
- Reserving files appropriately after assessing claim
- Where appropriate, negotiate and settlement of the Accident Benefits Claim
- Maintaining detailed file records on an electronic claims system
- Processing payments after confirming benefits, eligibility and reserves
- Confirming collateral benefits
- 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 benefits eligibility
- Preparing referral packages & obtaining the necessary medical information for insurer examinations
- Responding to assessment recommendations
- Participating in the dispute process
- Other duties as assigned
What do you bring to the role?
- University degree in any discipline or a college diploma or the CIP designation
- Minimum of 2 years Accident Benefits Claims handling experience, preference will be given to those with an Investigative background
- 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
We also take potential into consideration. If you don’t have this exact experience, but you know you have what it takes, be sure to give us more insight through your application and cover letter.
Go ahead and expect a lot — you deserve it, and we’ve got it:
- Hybrid work schedule for most roles
- Company share ownership program
- Pension and savings programs, with company-matched RRSP contributions
- Paid volunteer days and company matching on charitable donations
- Educational resources, tuition assistance, and paid time off to study for exams
- Focus on inclusion with employee groups, support for gender affirmation surgery, access to BIPOC counsellors, access to programs for working parents
- Wellness and recognition programs
- Discounts on products and services
Our inclusive work environment welcomes diversity and supports accessibility. If you require accommodation at any time during the recruitment process, please let us know by contacting: [email protected]
This role requires successful clearance of a background check (including criminal checks and leadership references).