Description:
The Claims Adjuster, Casualty (Intermediate to Senior) contributes to Wawanesa's goal of delivering an exceptional and consistent claims experience through proactive and fair investigation, evaluation, negotiation and settlement of high complexity and large loss casualty claims. This role is responsible for applying and explaining policy coverages and documenting claim files through the life of a claim. The role is accountable for providing timely service and prompt management of your claims pending from initial report to conclusion. The position level may be adjusted based on the candidate's experience.
Job Responsibilities
- Provide the best defense for members through proactive, fair, and thorough liability, coverage, and quantum investigation.
- Timely and proactive communication, through voice to voice, digital and written correspondence, ensuring that all inquiries are effectively dealt with in a timely and professional manner.
- Adjustment of Casualty claims of high complexity and large loss.
- Review and interpret policy wordings, determine policy coverage, and communicate coverage decisions to members.
- Establish timely and accurate loss and expense reserves throughout the life of the claim through evaluation of relevant information from various sources such as independent adjusters, medical, legal, financial, and vocational.
- Ensure a comprehensive investigation is conducted on all files to determine coverages and liability, while adhering to Wawanesa’s adjusting guidelines, and recognizing when to engage appropriate internal and external resources.
- Coordinate and manager services with vendors and services providers such as lawyers, engineers, accountants, and health practitioners.
- Negotiate with claimants, lawyers, and other insurers in order resolve claims at the best possible result for our members. Manage claims in litigation, mediation, or arbitration. Provide instruction to assigned counsel.
- Maintain an effective and current diary system and document claim file activities in accordance with established procedures.
- Demonstrate and maintain knowledge and understanding of policy coverages, while complying with regional regulatory and licensing requirements (as applicable). Remaining current with legislative changes and trends in the insurance industry.
- Occasionally participate at private mediation, court proceedings and other dispute resolution as required.
- Contribute to employee development through training, technical guidance, and coaching.
- Perform other duties as assigned.
Qualifications
- Exceptional customer service skills demonstrating empathy and concern for member satisfaction.
- 3+ years of insurance adjusting experience or equivalent.
- Post-secondary degree is preferred.
- Willingness to work toward Chartered Insurance Professional (CIP) designation and where required, dedicated to reach the proper licensing requirements.
- Excellent knowledge of medical and legal terminology.
- Excellent communication skills; listening, written, and spoken.
- Excellent investigative and analytical skills. Detail oriented with a high degree of accuracy regarding data entry.
- Excellent time management and organizational skills with the ability to prioritize work in a fast paced, changing environment.
- Excellent negotiation, decision making and critical thinking skills.
- Strong teamwork skills with the ability to collaborate with others.