Medical Claims Processor jobs

The Opportunity

The Sr Specialist, Casualty Large Complex & Specialty Claims is responsible for managing GL and ABI claims from start to finish, including complex specialty losses and those with multinational exposure. This role works closely with underwriting, reinsurance, actuary, and senior leadership to ensure effective claim strategies and outcomes. It also supports the evolution of claims capabilities to enable growth in new markets and specialty lines, while contributing to team development through ongoing mentoring and technical guidance.

What to Expect

• Manage a pending of complex large, complex Commercial General Liability and Auto bodily Injury claims from start to finish, including claims with complex coverage concerns.
• Engage all stakeholders in the effective management of a claim including underwriting, reinsurance, actuary, and senior leadership
• Support the transformation of claims capabilities to enable policy growth in new markets and specialty lines of business
• Contribute to ongoing mentoring and technical growth within Claims
•  Provide quality customer service and ensure file quality timely coverage analysis and communication with insured based on application of policy information to facts or allegations of each case.
•  Directly investigate each GL and ABI claim through prompt and strategically-appropriate contact with appropriate parties such as policyholders, accounts, claimants, law enforcement agencies, witnesses, agents, medical providers and technical experts to determine the extent of liability, damages, and contribution potential.
  Interview witnesses and stakeholders; take necessary statements, as strategically appropriate. Complete outside investigation as needed per case specifics.
•  Actively engage in the identification, selection and direction of appropriate internal and/or external resources for specific activities required to effectively evaluate claims.
• Verify the nature and extent of injury or damage by obtaining and reviewing appropriate records and damages documentation.
•  Maintain GL and ABI claim files and document claim file activities in accordance with established procedures Utilize evaluation documentation tools in accordance with department guidelines.
•  Utilize diary management system to ensure that all claims are handled timely. At required time intervals, evaluate liability & damages exposure.
•  Establish and maintain proper indemnity & expense reserves.
•  Recommend appropriate cases for discussion at roundtable.
•  Attend and/or present at roundtables/ authority discussions for collaboration of technical expertise resulting in improved payout on indemnity and expense.
•  Actively and enthusiastically share experience and knowledge of creative resolution techniques to improve the claim results of others.
•  Develop and employ creative resolution strategies.
•  Responsible for prompt and proper disposition of all claims within delegated authority.
•  Negotiate disposition of GL and ABI claims with insureds and claimants or their legal representatives.
•  Recognize and implement alternate means of resolution.
•  Manages litigated claims. Develop litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
•  Apply litigation management through the selection of counsel, evaluation and direction of claim and litigation strategy.
•  Track and control legal expenses to assure cost-effective resolution.
•  Attend depositions, mediations, arbitrations, pre-trials, trials and all other legal proceedings, as needed.
•  Update appropriate parties as needed, providing new facts as they become available, and their impact upon the liability analysis and settlement options.
•  Recognize cases, based on severity/complexity protocols, that should be transferred to another level of claim professional and refer on a timely basis.
•  Appropriately deal with information that is considered personal and confidential.
•  Fulfill specific service commitments made to certain accounts.
 Evaluate all claims for recovery potential; directly handle recovery efforts and/or engage and direct Company resources for recovery efforts.

What You Bring

• University degree in any discipline or a 2-year college diploma from a provincially recognized and funded community college or fully completed CIP designation
• A minimum of 8 - 10 years general claims handling experience
• The ideal candidate would have experience with most of these types of claims; GL/ABI greater than $150,000, Environmental, Abuse, Construction, Coverage B, Class Actions, Marine, National Accounts with large SIR/Deductibles and Additional Insured determination
• Experience coaching and mentoring junior staff
Strong interpersonal and communication skills

Salary Range : $73,500 - $123,500

Actual salary for the role may vary depending on work location of the successful candidate and other factors including but not limited to, skills, education, experience, working conditions and the local labour market.

This position is being posted to fill an existing vacancy.

Interested in this role, but don’t meet every requirement? We encourage you to apply! We know from experience that a candidate doesn’t need 100% of the qualifications listed to bring incredible value to our team. We’re actively seeking diverse backgrounds and perspectives to help us make insurance better. At Definity, inclusion, diversity, and equity aren’t just “nice to have” — they’re essential to our success.

What’s in it for you?

• Hybrid work schedule for most roles
• Company share ownership program
• Incentive Program - Eligible employees may participate in various incentive plans which are paid out at the discretion of the company and subject to individual and company performance.
• Pension and savings programs, with company-matched RRSP contributions
• Paid volunteer days and company matching on charitable donations
• Educational resources, tuition assistance, and paid time off to study for exams
• Focus on inclusion with employee groups, support for gender affirmation surgery, access to BIPOC counsellors, access to programs for working parents
• Wellness and recognition programs
• Discounts on products and services

Go ahead and expect a lot — you deserve it.

It’s better here — but don’t take our word for it. Definity was named by Great Place to Work ® as one of the Best Workplaces™ in Canada for women, for youth, and for inclusion.

Our inclusive work environment welcomes diversity and supports accessibility. If you require accommodation at any time during the recruitment process, please let us know by contacting accessibility@economical.com.

As part of Definity’s commitment to reconciliation, we acknowledge that our work, meetings, and travel take place on the lands now known as Canada, and recognize the enduring presence, wisdom, and stewardship of the First Nations, Métis, and Inuit peoples who have long cared for these lands.

Background checks

This role requires successful clearance of background checks (including criminal checks and leadership references).

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