Full-Time Technical Claim Leader
Job Description
Our client is a major Life Insurance Company.
The Technical Claim Lead represents our client in all legal related activities for Claims, assesses risk, uses independent authority to determine the amount of settlement as well as monitors compliance with both established department procedures and industry requirements. The incumbent is guided by defined procedural constraints and works under the broad supervision of the Chief Underwriter & Director, Claims and Underwriting Risk Management.
Responsibilities:
· Lead the claims portfolio through clear direction and coaching of team members to ensure compliance with existing and introduction of new required protocols and procedures
· Collaborate with key stakeholders regarding appropriate claim decisions, make recommendations regarding approval or denial of controversial or appealed decisions and escalate when appropriate to the Director and/or Claims Committee
· Assist internal and external legal counsel in the preparation of defense and other briefs, interpretations of facts, issues and associated risk
· Adjudicate death, disability, critical illness and waiver of premium claims outside of claim team approval limits; collaborate with Chief Underwriter and claim committee to determine claim eligibility based on risk management and underwriting guidelines as required
· Perform regular audits to ensure compliance with standard procedures and contractual guidelines and assess potential risk and appropriate next steps
· Identify and make recommendations to management regarding training on risk management; ensure technical training is completed
· Coach and mentor team members; identify employee training and development needs; and ensure the team is updated on trends and developments related to both internal legal cases and litigation related industry developments
· Participate as a subject matter expert on projects, implementation of changes to contracts, applications and other documentation that impacts claim adjudication
Qualifications:
· 8+ years solid experience in individual life and critical illness claims with a focus on underwriting and policy administration
· Completion of a university degree
· FLMI with Claims Specialty or working towards FLHC
· Strong experience working with contract interpretation and applicability of related Insurance Act and Quebec Civil Code legislation
· Bilingualism is an asset
· Knowledge of legal principles and practices
· Solid knowledge of claim adjudication for Life, Critical Illness, Waiver of Premium & Disability Income
· Solid knowledge of Individual Insurance operational procedures
· Ability to conduct research, investigate, analyze data and make recommendations
· Tact, diplomacy and the ability to handle confidential information
· Well-developed analytical and decision-making skills
How to Apply
Insurance Career Network is a recruitment agency focused exclusively on the insurance industry. Our relationships, knowledge and experience enable us to connect leading insurers, brokerages, and independent insurance firms with the most talented candidates for each role.
For consideration send your resume to jan@insurancecareernet.com or contact Jan at 416 703 5120 ext. 202
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