Manager Claims Business Controls

At Gore Mutual weve always set ourselves apart as a modern mutual that does good. Now were proudly building on that legacy to transform our companyand our industryfor the better.

Effective January 1 2026 Gore has joined Benevathe countrys largest mutual insurance companyas part of its Property & Casualty operations in Ontario and Western Canada. During 2026 Gore will combine its operations with Unica Insurance Benevas Ontario-based subsidiary specializing in niche commercial and personal insurance creating a stronger more diversified mutual insurer with greater scale and long-term stability.

Every decision and investment remains anchored in long-term benefits to customers members and communities. Come join us.

As the Manager Claims Business Controls you will own the endtoend Claims Business Control Environment driving a proactive datadriven firstline control strategy that enhances customer outcomes elevates quality and optimizes loss cost this role youll lead quality assurance across all lines of business strengthen processes and procedures and oversee control testing audits and risk programs to ensure strong governance and continuous improvement within Claims.

What you will do:

• Own the QA operating systemfor Claims (TFR automation manual QAR deep dives) includingmethodology sampling calibration and thresholds; ensure weekly/Monthly cadence and transparent reporting to leaders.
• Standardize QAR categories(e.g. Communication & Documentation Coverage/Investigation Cost Control) and ensure alignment with automated TFR attributes.
• Run crossLOB calibration(AB/APD/Casualty/Property) to improve consistency and embed phone call audit where required.
• Turn QA into action:deliver unit and adjusterlevel insights to Operations for coaching and track actions to closure without using QAR as performance management.
• Build and lead theClaims audit program for MGAs/DUAs and subscription programs.
• Maintain the Claims Procedures Manuals(endtoend file handling standards authorities audits vendor protocols) and ensure updates are synchronized across LOB manuals and the Corporate Procedures Manual.
• Embed file must speak for itself standardsfor documentation privacy and compliance; spotcheck adherence through routine internal reviews.
• Design and executefirstline control testing(beyond TFR/QAR) focused on leakage controls authority use reserve discipline SLA adherence and data integrity.
• Partner with leaders onaction plansand evidence packs; track remediation to timely closure and prevent repeat findings.
• Act asClaims SME and single point of contactfor external audits and reviews (e.g. reinsurer audits KPMG/EY financial audits SOC2/ITcontrol touchpoints that affect Claims workflows). Coordinate request lists samples walkthroughs and management responses.
• Serve asClaims lead for KRIs: define thresholds aligned to Risk Appetite publish monthly dashboards andescalate breacheswith rootcause and mitigation.
• Represent Claims atERM/Risk Championsforums; maintain evidence in corporate risk tools and ensure linkage to issue/mitigation programs.
• Coordinateregulatory readinessand control attestations that touch Claims processes (privacy fair treatment complaint handling etc.).
• Lead a small team (e.g. QA Analysts / Business Controls Analysts) set goals develop capability and manage workload planning.
• Champion a culture of insightful forward looking sustained health reporting in line with the Claims strategy.

What you will need:

• A minimum of7years in a leadership or managerial capacity within the insurance sector is essential. This experience ensures familiarity with the nuances and intricacies of leading teams managing operational workflows and handling the challenges unique to the insurance domain.
• The role demands a sound understanding of data analytics related to claims. An ideal candidate should have hands-on experience in extractinganalyzing and interpreting claims data to make informed decisions. Furthermorea track recordof using performance metrics tomonitor measure and improve claims processes is crucial.
• Familiar with allClaimslines of businesseswith hands on experience with Quality Assurance within Claims. Familiarity withinternal and external audit requirements to ensure the organization is meeting the required standards.
• Itsimperative for the candidate to have a history of successfully overseeing and resolving a diverse range of claims. This entails ensuring fair claim assessmentstimelyresolutions andmaintaininghigh client satisfaction rates. This experience is indicative of their ability to navigate complex claim scenarios manage client expectations and uphold the companys reputation.
• Given the regional focus an in-depth understanding ofCanadas insurance regulations market trends and customerbehavioursis crucial. This knowledge aids in ensuring compliance recognizing market shifts and adapting strategies to cater to regional needs and demands.

Permanent Full-Time

Hybrid: This is a hybrid role. Please note regular in-person workdays at our Cambridge Office or Toronto Office are expected minimum of two a week.

The expected base salary range for this position is$97000 - $147000. Depending on your relevant experience skills qualifications market conditions and business needs base compensation may vary. You have the potential to earn more through Gore Mutuals discretionary bonus program which gives you an opportunity to increase your total compensation provided the business meets its performance targets and you meet your individual goals.

Please note: This rangereflects the expected base salary for this role but may not represent the full compensation range for all experience and skill levels. During the recruitment process we will discuss and consider how your unique qualifications align with the broader range for this position.

Gore Mutual is proud to offer a comprehensive total rewards package which includes extended health and dental benefits disability insurance retirement plan matching paid time off recognition and perk programs.

This posting pertains to an existing vacancy that is actively being filled.

Accessibility for applicants

Gore Mutual Insurance Company is committed to providing accommodations for people with disabilities during all phases of the recruiting process including the application process.

If you require accommodation because of a disability we will work with you to meet your needs.Contact usand a human resources representative will consult with you to determine an appropriate accommodation.

Should you request an accommodation during the interview process please notify your Talent Acquisition Consultant.

Required Experience:

Manager

Employment Type : Full Time
Experience: years
Vacancy: 1
Monthly Salary Salary: 97000 - 147000