Casualty Claims Specialist

Job Overview

The Casualty Claims Specialist contributes to Wawanesa's goal of delivering an exceptional and consistent claims service experience through the fair and equitable adjustment of large to high complexity auto and/or non-auto bodily injury and property damage liability claims. This role is responsible for applying and explaining policy coverages and documenting claim files. The role is accountable for providing timely service and prompt management of your claims from initial report to conclusion.

Job Responsibilities

• Provide direction and support to our members, throughout the claims process, by providing exceptional service delivered with empathy 
• Ensure 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 Property and Casualty claims of large to high complexity.
• Review and interpret policy wordings, determine policy coverage, and communicate coverage decisions to members.
• Establish timely and accurate loss and expense reserves through the life of the claim through evaluation and reconciliation of relevant information from sources such as appraisers, independent adjusters, contractors, lawyers, and medical practitioners.
• 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. Collect evidence to support recovery efforts.
• Coordinate and manage investigations and services with vendors and service providers such as appraisers, independent adjusters, contractors, lawyers, engineers, and medical practitioners.
• Negotiating and conveying claim settlements within authority limits. Communicating claim decisions promptly and effectively, while still delivering an exceptional member experience.
• Maintain an effective and current diary system and document claim file activities in accordance with established procedures.
• Demonstrating and maintaining excellent 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.
• Understanding of Provincial and National Building Codes along with a solid understanding of residential and commercial construction terminology, techniques, and best practices.
• Maintain an advance knowledge of Provincial Legislative changes, arbitration decisions and case law which may impact Accident Benefits Claims.
• Demonstrating highly proficient skills to review repair estimates, create narrative scopes and generate intermediate to senior level estimates using an estimating software system.
• Participate at private mediation, court proceedings and other dispute resolution as required.
• Provide ongoing technical advice, guidance, peer coaching and mentoring to claims staff.
• Support CAT plan as necessary.
• Perform other duties as assigned
   

Qualifications

• Exceptional customer service skills demonstrating empathy and concern for member satisfaction.
• Minimum 6 years insurance adjusting experience, with strong knowledge of Commercial Lines Policy Wordings.
• Post-secondary degree is preferred
• Chartered Insurance Professional (CIP), or working towards designation and where required, dedicated to reach the proper licensing requirements.
• Exceptional knowledge of property estimating software, Xactware knowledge preferred.
• Ability to interpret and quantify property damage estimates.
• Excellent knowledge of medical terminology.
• Excellent communication skills; listening, written, and spoken.
• Excellent investigative and analytical skills.
• Strong problem solving and critical thinking skills. Ability to draw valid conclusions and effectively communicate them. Detail oriented with a high degree of accuracy regarding data entry.
• Excellent time management and organizational skills with the ability to prioritize in a fast paced, changing environment.
• Excellent negotiation, decision making and critical thinking skills.
• Strong teamwork skills with the ability to collaborate with others.

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