Claims Adjuster 1 - Accident Benefits

Job ID : 8318

Working Business Language : English

Salary : At Wawanesa, salary is only one component of a holistic, comprehensive and competitive offering that we provide to our employees.

In addition to salary, full-time and part-time permanent employees are eligible for an annual bonus plan, leave of absence top-up programs and provided with generous vacation time, personal days, premium free benefits and pension plan.

The salary offered for this role is determined with consideration to various factors, including but not limited to : your work location, local labour market conditions, external market salary data, internal pay equity and the knowledge, skills, experience and anticipated proficiency in the role.

The salary offered is estimated to be within the following range : $52,000 - $65,000. Candidates with salary expectations outside of the range are still encouraged to apply.

About Us

At Wawanesa, we're proud to offer a hybrid work environment that offers flexibility to our employees in balancing in-office (2 days per week OR 15 hours per week in a Wawanesa office) and remote work.

You may work from any of the following locations : Moncton, NB; Dartmouth, NS

The Wawanesa Mutual Insurance Company ("Wawanesa Mutual"), founded in 1896, is one of Canada's largest mutual insurers, with over $3.

5 billion in annual revenue and assets of $10 billion (CAD). Wawanesa Mutual, with its National Headquarters in Winnipeg, is the parent company of Wawanesa Life, which provides life insurance products and services throughout Canada, and Western Financial Group, which distributes personal and business insurance across Canada.

Wawanesa proudly serves more than 1.7 million members in Canada, and we are home to more than 3,600 employees distributed across the Canadian regions and communities where we operate.

We give back to organizations that strengthen communities, donating more than $3.5 million annually to charitable organizations, including over $2 million annually in support of people on the front lines of climate change.

To learn more visit wawanesa.com.

We are currently looking for dedicated, driven, and enthusiastic individuals who thrive in an environment that welcomes change and are looking for an opportunity for diverse experience and advancement on a growing team.

Job Overview

The Claims Adjuster 1, Accident Benefits contributes to Wawanesa's goal of delivering an exceptional and consistent member experience through the fair and equitable adjustment of low to moderate complexity accident benefit claims.

This role is responsible for applying and explaining policy coverages and documenting claim files through the life of a claim.

The role is accountable for providing timely service and prompt management of your claims pending from initial report to conclusion.

Job Responsibilities

• Provide direction and support to our injured members through throughout the claims process, by providing an exceptional member experience delivered with empathy.
• 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 Accident Benefit claims of low to moderate complexity.
• Review and interpret policy wordings, determine policy coverage, and communicate coverage decisions to members.
• Establish timely and accurate loss and expense reserves throughout the life of the claim through evaluation of relevant information from various sources such as medical, legal, financial, and vocational.
• 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.
• Coordinate and manage services with vendors and service providers such as accountants, lawyers, rehabilitation clinics and health practitioners.
• Negotiating and conveying claim settlements within authority limits. Communicating claim decisions promptly and effectively, while still delivering an exceptional member experience.

Prepares files for arbitration and litigation.

• Maintain an effective and current diary system and document claim file activities in accordance with established procedures and Wawanesa's Proactive Case Management Model.
• Demonstrate and maintain 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.

• Liaise with claimants, doctors and rehabilitation specialists Doctors, Lawyers, Employers, Treatment Providers, Case managers, Clinical Resource Team, Return to Work Team, and Injured Members in accordance with Wawanesa's Proactive Case Management approach.
• Ontario Only : Manage Loss Transfer & WSIB exposure. LAT process management & priority disputes. Manage priority of payment investigation, WSIB and Loss Transfer.
• Perform other duties as assigned.

Qualifications

• Exceptional customer service skills demonstrating empathy and concern for member satisfaction.
• 1 year of insurance adjusting experience or equivalent.
• Post-secondary degree is preferred
• Willingness to work toward Chartered Insurance Professional (CIP) designation and where required, dedicated to reach the proper licensing requirements.
• Basic knowledge of medical terminology.
• Excellent communication skills; listening, written, and spoken.
• Excellent investigative and analytical skills. Detail oriented with a high degree of accuracy regarding data entry.
• Excellent time management and organizational skills with the ability to prioritize work in a fast paced, changing environment.
• Good negotiation, decision making and critical thinking skills as well as a willingness to improve.
• Strong teamwork skills with the ability to collaborate with others.
• Proficiency in English and French (written and spoken) is an asset.

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Wawanesa is proud to be one of Manitoba's Top Employers, a Kincentric Best Employer in Canada and a Forbes Best Employer in Canada recognizing an exceptional place to work!

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