This is a fully remote position, open to applicants in Canada.

📋 Description

• Evaluate mid- and higher-level general liability claims to ascertain benefits owed.

• Ensure continuous claims adjudication in accordance with company standards and industry best practices.

• Identify subrogation opportunities for claims and engage in settlement negotiations.

• Collect information to assess liability exposure.

• Assign reserve amounts, process claims payments, and settle claims within designated authority limits.

• Analyze liability and resolve claims during the evaluation process.

• Approve and manage assigned claims, determine benefits owed, and implement action plans in line with the claim or client contract.

• Oversee subrogation efforts for claims and negotiate settlements.

• Communicate claim actions to claimants and clients effectively.

• Ensure comprehensive documentation of claim files and correct claims coding.

• Handle complex lifetime medical and/or defined period medical claims as necessary, which may include state and physician filings and treatment decisions.

• Foster professional relationships with clients.

• Contribute to the organization's quality programs.

• Perform additional duties as assigned.

⛳️ Requirements

• A minimum of four (4) years of experience in claims management or a relevant combination of education and experience is required.

• A bachelor's degree or college diploma is preferred.

• Expertise in relevant insurance principles and laws, recoveries, offsets and deductions, claim and disability duration, and cost containment strategies.

• Exceptional oral and written communication skills.

• Proficient in PC operations, including Microsoft Office applications.

• Strong analytical and interpretive abilities.

• Excellent organizational skills.

• Good interpersonal abilities.

• Outstanding negotiation skills.

• Capability to work collaboratively within a team environment.

• Ability to meet or exceed service expectations.

• Willingness to travel as necessary.