Claims Examiner

Number of Vacancies : 1

Office Hours:

8:30AM – 4:30PM

May be required to attend after-hours functions/meetings

Healthcare Insurance Reciprocal of Canada (HIROC)

is a trusted healthcare safety advisor, committed to offering a full spectrum of insurance, risk and claims management products and support.

HIROC knows healthcare as it’s the largest not-for-profit healthcare liability insurer in the country, with over 700+ healthcare organizations part of the Reciprocal. Combined with sage counsel and risk management solutions, HIROC works with its partners to increase safety.

As a Reciprocal, HIROC is governed by its Subscribers and remains an innovative, agile, and proactive partner. Since its inception in 1987, the not-for-profit has returned over $260 million to the healthcare system. HIROC’s 35 years of data is combined with its extensive experience to advise and share learnings, all with the goal of scaling knowledge and increasing safety across Canada’s healthcare system.

One common thread running through HIROC’s culture is the feeling of being part of something unique: partnering to create the safest healthcare system – HIROC’s vision.

Each employee has the opportunity to find their calling and help build a stronger organization designed to meet the needs of its Subscribers. As a Top 100 GTA Employer ten years running, HIROC employees are empowered to find solutions and create amazing experiences in service to its Subscribers.

Join us and be part of the team working to make a difference.

SUMMARY: Reporting to the Lead, Claims, the Claims Examiner’s primary responsibility is to collaborate with internal partners and subscribers to ensure the effective resolution of claims. The role will focus on investigating, analyzing and providing accurate and transparent information to all parties involved in the claims process.

KEY RESPONSIBILITIES: Claims Function:

Review initial documentation, apply legal/claims analysis and set/amend reserves

Instruct adjuster/lawyer on a continuing basis, settle/deny/defend decisions

Ensure required information/evidence is collected & preserved, authorize expense payments, mediations & pre-trails

Conduct/control negotiations with plaintiff counsel, mediators, pre-trial judges, and claimants

Make settlement decisions up to the posted reserve of assigned claims, authorize settlement payments. Handle special-focus-area of specialty claims as assigned.

Subscriber Interaction:

Policy Interpretation

Situational Analysis & Recommendations for actions on non-claim matters

R/M Advice

Interaction with Other HIROC Departments:

R/M: Education and Developing Coordinated Responses to Situations

I/O: Policy Development and Revision, Education as to new legal developments

Teach/Learn Function:

Continuous skills and knowledge upgrading (negotiation, insurance knowledge, computer abilities, legal developments, court trends, settlement amounts)

Present to HIROC Subscribers/Healthcare administrators on Insurance & Claims Matters

Other duties as assigned

KNOWLEDGE, SKILLS & ABILITIES

Ability to work in a team environment.

Ability to problem solve and balance multiple priorities to ensure timelines are met. Strong analytical skills with the ability to apply principles of logic and scientific thinking to a wide range of problems

Excellent verbal and written communication skills with the ability to clearly articulate complex ideas to a wide range of stakeholders.

EDUCATION, TRAINING & EXPERIENCE:

Completed post-secondary education and 5 years related work experience or an equivalent combination of education and experience.

Enrollment in or completion of CIP/FCIP required courses

An enthusiastic and creative thinker, who is constantly driving performance improvement and is passionate about creating the safest health care system possible for Canadians.

Valid G driver’s license and access to a vehicle

WORKING CONDITIONS:

Working at a computer for much of the day

Monday-Friday 8:30am–4:30pm.

May be required to attend after-hours functions/meetings

SALARY RANGE:

$76,000.00 - $90,000.00

The salary range offered for this position will be determined by a variety of factors including the candidate’s skills, competencies, qualifications and relevant experience, in accordance with HIROC’s Compensation Policy.

HIROC is committed to fostering a climate of equity, diversity, inclusion, and accessibility. HIROC respects the diversity of all members of its community and welcomes applications from those who have demonstrated a commitment to the values of equity, diversity and inclusion. Applications from members of groups that have been historically disadvantaged and marginalized, including First Nations, Métis and Inuit peoples, racialized persons, persons with disabilities, those who identify as women, 2SLGBTQ+, individuals who self-identify on the basis of any of the protected grounds under the Human Rights Code and/or others who may contribute to the further diversification of ideas within its community are encouraged. HIROC is committed to fair assessment of a candidate’s abilities, and consideration for diversity of thought, method, and experience, including non-traditional career paths.

HIROC is committed to providing a barrier-free environment for all stakeholders, including its participants, employees, job applicants, suppliers, the public and any visitors who may enter its premises, access its information, or use its services. As an organization, HIROC respects and upholds the requirements set forth under the Accessibility for Ontarians with Disabilities Act (AODA) and its associated standards and regulations and will ensure that HIROC offers a safe and welcoming environment that is respectful of each person's dignity and independence.

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