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Senior Claims Adjuster, Accident Benefits

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Job ID : 5789
Category : Claims
Brand : Definity
Regular/Temporary : Regular
Fulltime/Parttime : Full Time
Location : Mississauga, Canada

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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.

Starting in September, Definity employees move to a hybrid work model so we can collaborate, build mentoring relationships, and solve complex or cross-functional business opportunities together. Our teams work in whichever environment best supports what they're working on and who they're working with. We're actively reinventing our offices as welcoming workspaces that optimize collaboration and empower leaders to use our space to strengthen team dynamics. Our tools and processes seamlessly connect employees from multiple locations, and our culture encourages respectful engagement and flexibility. Leaders work with their teams to determine the right balance of on-site and remote work that best meets the needs of their team, cross-functional engagement, responsibilities and timelines, plus those of our customers, our broker partners, and the company culture.

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

What can you expect in this role?

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.

  • Securing details of claims by corresponding with claimants and/or representatives
  • 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 election of benefit claims
  • 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 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 4 years Claims handling experience
  • Experience handling mediations
  • 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
  • An incredible team of smart, diverse, and supportive people that want to help you be better at what you do
  • Great benefits, ongoing education, and competitive pay
  • Unexpected perks to keep things fun

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]

Background checks
This role requires successful clearance of a background check (including criminal checks and leadership references).

#LI-Hybrid

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