Claims Examiner
Unica Insurance Inc.
Date: 1 week ago
City: Mississauga, ON
Contract type: Full time
Official Internal Job Title
Claims Adjuster - Reviewer
Status
Regular
Job Description
Under the direct authority of the Assistant Director, the incumbent verifies the execution of activities related to the processing of major claims and acts as a senior reviewer for independent adjusters. They analyze claims files and authorize settlement according to their limit of authority. They review the files of individuals and companies.
Summary Of Role & Responsibilities
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Claims Adjuster - Reviewer
Status
Regular
Job Description
Under the direct authority of the Assistant Director, the incumbent verifies the execution of activities related to the processing of major claims and acts as a senior reviewer for independent adjusters. They analyze claims files and authorize settlement according to their limit of authority. They review the files of individuals and companies.
Summary Of Role & Responsibilities
- Participate in the assignment of files to independent adjusters and other experts.
- Review major claims files in personal and commercial insurance
- Follow up with the independent adjuster within 24 hours of assignment of major losses, to get an overview of the incident for reporting and reserving purposes
- Summarize and present major claims files to their manager in order to establish a strategy based on the cause, recovery possibilities, fraud detection and underwriting
- Present major claims files to the Major Loss Committee
- Assist the independent adjuster in their investigation and provide guidance and direction
- Receive and evaluate settlement proposals submitted by independent experts. Confirm and apply limitation periods and close the file
- Find an appropriate and satisfactory solution to claims for which there is no precedent or adequate standards, after considering all elements of the investigation as well as the potential repercussions for the client(s) and the company, based on in-depth knowledge of the principles of indemnification
- Act as a resource person and mentor to senior and intermediate claims adjusters (including other reviewers), passing on their knowledge and experience, in order to help them take charge of increasingly important files
- Identify files with potential for fraud and take the necessary investigative actions. Identify recovery opportunities and involve the subrogation unit as applicable
- Ensure that the reserves for each file reviewed are adequate as the files progress
- Request, if necessary, a legal opinion or an expert opinion and participate in and attend any matters of litigation and dispute resolution including mediations, arbitrations, appraisals and discoveries
- Participate in the training of claims adjusters in the unit
- Participate in the development of claims policies, standards and procedures as required
- Support technical specialists during busy periods. Make recommendations to the Vice-President regarding the assessment of post-disaster risks and suggest corrections to be made
- Perform all other tasks as required
- Superior proficiency with large losses
- Highly familiar with the principles of claims adjusting
- Familiarity with the laws in force in the context of his/her work
- Demonstrate excellent interpersonal communication skills, including tact and diplomacy
- Demonstrate creativity and innovation in problem solving
- Experience settling major and non-standard claims
- Possess good judgment, initiative, empathy, be a team player, negotiation skills, autonomy, flexibility, and ability to adapt to change
- Minimum of 10 years of experience as an external claims adjuster or examiner, with experience handling major fires and commercial risks
- Currently hold or working toward CIP designation
- Bilingualism in English and French is an asset
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