Team Leader, Quality Services

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

📋 Description

• Lead the teams responsible for Life & Critical Illness Claims and Appeals.

• Provide daily leadership, coaching, guidance, and technical expertise to adjudicators and Appeals specialists.

• Support claims that are complex, sensitive, or set precedents.

• Ensure that Appeals reviews are objective, consistent, timely, and adhere to service standards.

• Manage workload distribution, case prioritization, and overall team performance.

• Interpret contracts related to Life, Critical Illness, and Disability.

• Review complex or escalated cases and offer recommendations or direction.

• Ensure that decisions are well-reasoned, documented, and consistent with policy language and best practices.

• Identify decision-making trends and coach employees to enhance adjudication quality.

• Improve claims processes, workflows, and decision-making tools.

• Collaborate with Operations, Medical, Legal, and other internal partners to develop guidelines and procedures.

• Create and maintain training materials, job aids, and reference documents.

• Engage in system and process improvement initiatives.

• Prepare reports on team performance, Appeals outcomes, trends, and emerging issues.

• Communicate updates, risks, and recommendations to leadership.

• Set objectives, conduct performance evaluations, and formulate action plans.

• Cultivate a collaborative, supportive, and high-performance team culture.

⛳️ Requirements

• A post-secondary degree from a university or college.

• At least 5 years of prior experience in Life, Critical Illness, and/or Disability Claims.

• A minimum of 10 years of experience within the insurance industry, focusing on Life and Disability.

• At least 1 year in a supervisory role within Life and Disability Case Management.

• A strong understanding of adjudication and Appeals processes.

• Proven leadership capabilities with the ability to coach, support team performance, and effectively drive high engagement.

• Excellent communication abilities.

• Strong analytical and decision-making skills.

• Capability to manage competing priorities effectively.

• In-depth understanding of contract language and claims practices.

• Bilingual in French and English.

• Proficiency in English is required for daily collaboration with teams and partners outside of Québec.

🏝️ Benefits

• Health and dental coverage fully paid by the employer from day one.

• Wellness benefits.

• Access to health resources.

• Discounts for fitness center memberships.

• A flexible work environment that supports work–life balance.

• Opportunities for professional development, including leadership programs and continuous learning.

• Clear pathways for career growth.

• A collaborative and inclusive culture.

• Performance-based incentive programs available for eligible employees.