AB Claims Representative I

What you will do...
 
Manage a caseload of minor to moderate injury accident benefit files. This is a telephone adjusting position. Files are generally those with injuries that fall within the minor injury guideline, or if outside of the MIG, are less complex in terms of recovery, benefit eligibility, concurrent claims or other complicating factors. Claimants may be represented by legal counsel.
  

• Interview claimants to ensure we have adequate information to confirm priority of payment, WSIB and/or loss transfer potential.
• Provide counsel and direction to claimants regarding SABS, benefit eligibility, claims process and procedures, including use of FSCO approved forms or formal correspondence, as required.
• Manage treatment plans and invoicing within the HCAI system--arrange for timely payment, and response within regulation timelines.
• Request and review medical records, summarizing key information in the file journal.
• Ensure all files are tracked and kept up-to-date through consistent use of our diary system.
• Process specified benefit cheques within guidelines.
• Ensure adequate reserving throughout the life of the file.
• Co-ordinate medical examinations with the AB Claims Assistant, as required.
• Effectively adjudicate a caseload of minor to moderate injury cases in accordance with the SABS.
• Maintain file records and documents in a paperless work environment.
• Monitor reserve adequacy in compliance with company guidelines.
• Ensure the daily claims procedures and best practices conform to legal, regulatory and privacy obligations.
• Deal with claimants and legal representatives in a courteous and professional manner.
• Develop strong customer relationships through professional accountability.

What you will bring...

• Prior adjusting experience in an auto PD role.
• A solid understanding of the OAP 1 and the Ontario SABS.
• College diploma or a post-secondary certificate. • Effective communication skills.
• Strong organizational skills.
• CIP or enrolment in the program is preferred.
• 2+ years handling AB claims, with some experience with non-MIG and specified benefit claims is an asset.