Sr. Claims Specialist, Accident Benefits

Sr. Claims Specialist, Accident Benefits

Job Information
Author pmnationtalk
Date August 30, 2021
Deadline Open
Type Full Time
Company Zurich Canada
Location Toronto, ON
Category Claims
Client Zurich Canada
Contact Information
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Sr. Claims Specialist, Accident Benefits


Job Summary

With moderate direction, we are looking for a highly motivated individual to handle single and multi-party Accident Benefit and Loss Transfer claims, of low to moderate exposure and complexity for commercial Insureds.  Within the authority provided, you will follow established protocols to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.

Job Qualifications

Basic Qualifications: • Juris Doctor and 2 or more years of experience in the Claims and Litigation area within the Insurance industry

• Bachelors Degree and 4 or more years of experience in the Claims and Litigation area

• High School Diploma or Equivalent and 5 or more years of experience in the Claims and Litigation area within the Insurance industry

• Knowledge of the insurance industry, claims and the insurance legal and regulatory environment
• Knowledge of claims handling or insurance legal statutes and procedures

• Ability to interpret coverage on various liability policies

• Customer service experience

Preferred Qualifications: 

• Analytical skills
• Negotiation experience
• 3 or more years of claims experience in line of business
• Strong communication skills
• Ability to multi-task and adapt to a changing environment
• Organization and time management skills
• Experience collaborating across work groups
• Microsoft Office experience

Job Accountabilities

• Document claims file by accurately capturing and updating data/information in

compliance with best practices for claims of low to moderate exposure and complexity.

• Exercise judgement to determine liability (for AB Loss Transfer Claims) by gathering and

analyzing relevant facts; utilizing applicable FDR and/or case law.

• Exercise judgment to determine policy verification and coverage determination by analyzing

applicable coverage for claims and determining whether the loss falls within the coverage.

• Work to have a timely resolution to claims by developing case strategy; escalating issues as appropriate.

• Establish timely reserves and perform ongoing review throughout claims cycle within

authority limit by estimating and validating value of claims.

• Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing

available tools and resources within authority limits.

• Meet quality standards by following best practices.

• Provide a high level of customer service by proactively communicating information; responding to inquiries;  following customer protocols.

  • Participate in claim reviews or other customer marketing efforts.
    • Manage expenses by working within vendor approved networks and managing scope of work
    assigned to outside contractors.
    • Ensure legal compliance by following provincial laws and regulations and internal control
    • Review files for red flags and refer to SIU when appropriate for further investigation.
    • Contribute to profitable growth by providing risk insight, information and trends to Business
    Unit or customer as needed.
    • Protect Zurich’s reputation by keeping claims information confidential.
    • Maintain professional and technical knowledge by participating in educational opportunities,
    staying current with industry trends, establishing personal networks, and participating in
    professional societies.
    • Business Travel, as required
    • Extended Hours during Peak Periods, as required

Additional Job Functions

• May manage litigation by assigning counsel within the approved panel where applicable;

establishing litigation plan and budget; coordinating defense lawyer activities; continuously

reviewing the potential for settlement with claimant; reviewing litigation expenses and

authorizing payments.

Business Accountabilities

• Anticipate, recognize and respond timely to inquiries regarding low to medium complexity

and exposure commercial claims to contribute to customer satisfaction.

• Provide technical advice that enables a customer to solve a problem or improve business.

• Acquire and organize the relevant evidence and information to accurately assess the value of

the claim.

• Collect data and document in established system to facilitate decision-making.

• Adhere to local regulatory and governance requirements throughout the life of a claim to

ensure decisions are made using the right standards.

• Assess and appoint claims vendors within agreed authority limits aligned to the organization´s

Claims Vendor Management strategy.

• Determine when to solicit input from more senior colleagues or managers for more complex

issues, to ensure quality and continuous learning.

• Provide feedback on business processes and systems to identify opportunities for


Performance Management Accountabilities

• Model behaviors that demonstrate commitment to corporate values.

• Provide input into performance management discussions of project team members.

• Educate team members and business partners on area of technical expertise.

• Provide guidance and support for team members.

• Take action to manage own personal development and encourage others to do the same

Skills/Experience and Education specific to Accident Benefits

 Bachelor’s Degree and 3-5 years of experience handling Accident Benefits & Litigation.

  • Knowledge and understanding of the 3 different thresholds of injury classification.
  • Understanding of Priority Rules in determining which Insurer is responsible to handle a claim.
  • Knowledge about claims involving WSIB, and the interplay with SABS.
  • Understanding of the differences between Employed vs Self-Employed.
  • Understanding of the application of and nuances about Loss Transfer claims.
  • Working knowledge of the HCAI system.
  • Knowledge of the Claimant’s dispute resolution system, the LAT.
  • Experience and/or understanding of Insurer’s dispute resolution system, Arbitration.
  • Experience with Guidewire Platform is an asset.
  • Experience handling and/or knowledge of Section B in other provinces is an asset.

A future with Zurich

Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 148 years of experience managing risk and supporting resilience. We are a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. Today, we serve more than 25 industries, from agriculture to technology and insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, Zurich strives to provide ongoing career development opportunities and foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our people, our customers and the communities we serve.

As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich is committed to providing a diverse, inclusive and barrier-free environment resulting in an accessible organization for employees, customers, and other parties who interact with, or on behalf of, Zurich. We strive to achieve a workplace free of discrimination of all forms, including discrimination on the basis of physical or mental disability, or medical condition. If you are interested in a job opportunity, please advise if you require an accommodation, so we can work with you to provide a more accessible process.

Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich Canadian Holdings Limited. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission.

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