Claims Examiner

LOCATION: Altona or Winnipeg, MB
SCHEDULE: Full-time
REPORTS TO: Claims Manager
DIRECT REPORTS: N/A

COMPANY PROFILE:
Red River Mutual is a progressive insurance company with a focus on our customers and employees. We believe everyone has a right to feel safe and protected, and to know that someone is looking out for them.  So we treat our employees like family members – we’ll be honest with them, support them, offer a listening ear, admit when we’re wrong and be a positive force in their lives and in our communities.

PURPOSE OF POSITION:
The Claims Examiner (JR) is responsible for providing direction on basic straight forward wording questions, or direction/resolution related to low or non-complex customer complaints. This role also acts as the Reinsurance Coordinator for set up and reporting of all reinsurance claims to Red River Mutual reinsurer. The Claims Examiner (JR) assists the Claims Examiner with reviewing reports and setting up all new claim assignments received at Red River Mutual.

KEY RESPONSIBILITY AREAS:
Report Review

  • Assist the Claims Examiner with reviewing less complex claims
  • Reviewing scenarios to ensure the policy provides coverage for the loss, reviewing estimates & invoices to ensure accuracy
  • Process the payments in Guidewire, and ensure all final documentation is received to conclude a file.
  • Correspond with the Independent Adjuster throughout the life of the claim providing direction, including options for settlement, coverage confirmation and/or coverage denial authorization.
  • Year-end reserve review for external adjusters, send out reserve review requests and process revisions as received.

Reinsurance Coordinator

  • Act under the direction of the Reinsurance Manager to set up and provide updates for all reinsurance programs as per the guidelines of company treaties. *Report new claim assignments & provide updates monthly on files that have had activity during the month.
  • Responsible for equipment breakdown claim reconciliation against Mutual Boiler Re, any discrepancies must be reviewed and corrections made as necessary.
  • Review and respond to miscellaneous questions received from the reinsurer.

New Claim Set Up

  • Retrieve new claim information from broker/Insured
  • Request DEC print from system
  • Contact Insured to confirm receipt of claim, confirm date of loss, contact information, email address, and loss details including providing guidance regarding initial triage of claims
  • Open new claim wizard in Guidewire and populate fields including documenting conversation with insured
  • Upload claim notification, DEC, any relevant underwriting information
  • Dispatch new claim to appropriate staff or external vendor (Independent Adjuster) if the Claims Examiner is absent or requires assistance.

Dealing with Stakeholders

  • All call inquiries are channeled to Claims Support for triage
  • Claims Support will listen to the situation and decide if they can assist or if the call needs to be directed to another person
  • Claims Support will assist with low complexity coverage questions, by referring to the policy wordings to find the answer. Calls are received from all stakeholders
  • Claims Support will handle inquiries received from Claimants regarding their claim, most often the caller is looking for direction and/or status of their claim including where the payment is at. Occasionally the caller is looking for approval of an estimate. This would be escalated to the owner of the file or Supervisor to assist with providing the caller direction.
  • All phone conversations are documented in Guidewire in the claim file.

Miscellaneous

  • Responsible for ensuring claim recovery information is entered into Guidewire, Claims Specialists are notified of the recovery, and cheques are processed by Accounting.
  • Review stale dated cheques report and assist in the process of cancelling and reissuing the cheque.
  • Conduct Guidewire testing
  • Act as the support person for troubleshooting Guidewire questions from employees
  • Provide follow up calls to claimants who participated in the claims survey

QUALIFICATION AND SKILLS:

  • 1+ years in the claims experience within the P&C insurance industry
  • CIP designation is preferred
  • High school diploma required
  • Post-secondary education in business or related field is considered an asset
  • Excellent customer service
  • Excellent organization skills
  • Strong attention to detail
  • Strong communication across mediums (verbal, written and oral) are required
  • Time management and prioritization

Location:

2445 Pembina Hwy
Winnipeg, MB

Job type: Full-time

Apply Now

Contact Information

Red River Mutual

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