Medical claims processor Jobs in Halifax, NS

Job Overview

The Casualty Claims Specialist contributes to Wawanesa's goal of delivering an exceptional and consistent claims service experience through the fair and equitable adjustment of large to high complexity auto and / or non-auto bodily injury and property damage liability claims. This role is responsible for applying and explaining policy coverages and documenting claim files. The role is accountable for providing timely service and prompt management of your claims from initial report to conclusion.

Job Responsibilities

• Provide direction and support to our members, throughout the claims process, by providing exceptional service delivered with empathy.
• Ensure timely and proactive communication, through voice to voice, digital and written correspondence, ensuring that all inquiries are effectively dealt with in a timely and professional manner.
• Adjustment of Property and Casualty claims of large to high complexity.
• Review and interpret policy wordings, determine policy coverage, and communicate coverage decisions to members.
• Establish timely and accurate loss and expense reserves through the life of the claim through evaluation and reconciliation of relevant information from sources such as appraisers, independent adjusters, contractors, lawyers, and medical practitioners.
• Ensure a comprehensive investigation is conducted on all files to determine coverages and liability, while adhering to Wawanesa’s adjusting guidelines, and recognizing when to engage appropriate internal and external resources. Collect evidence to support recovery efforts.
• Coordinate and manage investigations and services with vendors and service providers such as appraisers, independent adjusters, contractors, lawyers, engineers, and medical practitioners.
• Negotiating and conveying claim settlements within authority limits. Communicating claim decisions promptly and effectively, while still delivering an exceptional member experience.
• Maintain an effective and current diary system and document claim file activities in accordance with established procedures.
• Demonstrating and maintaining excellent knowledge and understanding of policy coverages, while complying with regional regulatory and licensing requirements (as applicable). Remaining current with legislative changes and trends in the insurance industry.
• Understanding of Provincial and National Building Codes along with a solid understanding of residential and commercial construction terminology, techniques, and best practices.
• Maintain an advance knowledge of Provincial Legislative changes, arbitration decisions and case law which may impact Accident Benefits Claims.
• Demonstrating highly proficient skills to review repair estimates, create narrative scopes and generate intermediate to senior level estimates using an estimating software system.
• Participate at private mediation, court proceedings and other dispute resolution as required.
• Provide ongoing technical advice, guidance, peer coaching and mentoring to claims staff.
• Support CAT plan as necessary.
• Perform other duties as assigned.

Qualifications

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Wawanesa is proud to be one of , a in Canada and a in Canada recognizing an exceptional place to work!

Diversity Equity, Inclusion & Belonging

Wawanesa is an equal opportunity employer and is committed to fostering a diverse workforce that is equitable and inclusive for all. Wawanesa provides equal employment opportunity to all employees and applicants without regard to an individual’s protected status : race / ethnicity, colour, religion, creed, sex or gender, sexual orientation, gender identity or expression, family or marital status, pregnancy / childbirth or related conditions, national origin, disability, military or veteran status, or any other protected status. Disability or medical-related accommodations are available upon request throughout all aspects of the recruitment and selection process.