Claims Specialist

• Enter and manage dental claims and treatment plans to ensure timely payment for providers and members
• Research and compile information from various sources to resolve inquiries and claim discrepancies
• Consult with senior staff when assistance is required
• Contact providers to obtain necessary information to assess claims
• Adjudicate claims according to Dental Provider Services policies and standards
• Monitor individual production to meet claim turnaround expectations
• Suggest workflow improvements and increase efficiency
• Review and update documentation as required

Dental Claims Coordinator – Provider Services

• Investigate and adjust residential and commercial property and casualty claims with little to no supervision
• Inspect claims and contact involved parties in a timely manner
• Investigate claim circumstances for coverage determination, cause, compensable damages, and reserves
• Examine insurance policies and records to determine coverage
• Prepare repair and replacement cost estimates
• Interview claimants and witnesses
• Negotiate and settle first- and third-party claims
• Address salvage and subrogation as required by the client
• Maintain client relationships to support repeat business referrals
• Support organizational quality programs
• Perform other assigned duties
• Travel as required

Senior Claims Adjuster – Accident Benefits

• Investigate and negotiate Ovation and RBC High New Worth / RBC Private Insurance property claims according to Aviva’s methodologies and handling procedures
• Issue payments to vendors, customers, and experts
• Analyze estimates and claim values, negotiate, and settle claims
• Interpret and apply Aviva Ovation high net worth personal policy coverage
• Communicate policy coverage and benefits to customers
• Investigate and document cause of loss and quantum
• Review, comment on, and approve vendor partner estimates for repairs or replacement
• Maintain relationships with internal and external claims partners
• Acquire and maintain appropriate provincial adjuster licenses and continuing education requirements where required
• Manage customer relationships and outcomes for claims of varying quantum and complexity
• Determine when fieldwork is required and coordinate field resources and information
• Identify exposures and recovery opportunities during storm and disaster events
• Apply financial understanding of property claims to improve business performance
• Maintain accurate and reliable data in Aviva systems
• Identify and report suspected fraud or financial irregularities
• Continuously improve customer experience, outcomes, indemnity, and expense excellence
• Demonstrate regulatory and legislative compliance

High-Net-Worth Property Claims Adjuster

• Investigate automobile insurance claims on behalf of insurers or third parties
• Gather relevant information related to losses
• Determine coverage and claim validity
• Communicate with insureds and claimants
• Prepare reports and negotiate settlements
• Maintain concise and accurate records in internal computer systems
• Review and interpret policy wording to apply coverage
• Manage billing for assigned files within prescribed timelines
• Maintain excellent working relationships with existing clients
• Participate in ongoing training on industry issues, legislative changes, and trends
• Identify needs and coordinate the assignment of mandates to field claims adjusters
• Perform any other related duties as assigned

Claims Adjuster – Auto

• Enter and manage claims to ensure timely payment for providers and members
• Research and compile information from various sources to resolve inquiries and claim discrepancies
• Consult with senior staff when assistance is required
• Respond to internal customer inquiries regarding benefits and claims assessment
• Follow through to resolve inquiries effectively and efficiently
• Contact providers and members to obtain information needed to assess claims
• Adjudicate claims according to unit procedures and Claim Services standards
• Monitor individual production to meet claim turnaround and volume expectations
• Suggest improvements to workflows and processes

Claims Coordinator – Claim Services

• Gather statements from policyholders and/or witnesses regarding thefts or fires involving all types of vehicles
• Determine whether claims are covered by analyzing the required coverages and comparing them with those provided under the policy
• Collaborate with the Special Investigations Unit (SIU) or the Recovery Department, as applicable
• Gather statements regarding automobile accidents occurring outside the province of Quebec and validate out-of-province use
• Analyze the information obtained and make the decisions required to determine liability
• Review damage assessments and settle claims fairly and equitably
• Communicate with policyholders and other interested parties to negotiate and authorize claim settlements
• Comply with established standards in accordance with the permitted level of authority
• Promptly escalate files to the Out-of-Quebec Bodily Injury team
• Settle files in accordance with the laws and regulations of the relevant countries/regions

Senior Claims Adjuster, Auto – Theft, Fire and Major Accounts

• Gather statements from policyholders and/or witnesses regarding the facts of the loss
• Determine whether the loss is covered by analyzing the applicable coverages and comparing them with those provided under the policy
• Collaborate with the Special Investigations Unit (SIU) or the Recovery Department, as appropriate
• Interview policyholders and/or witnesses regarding commercial auto accidents
• Analyze the information obtained and make decisions to establish liability
• Review damage estimates and settle claims fairly and equitably
• Communicate promptly with policyholders and other interested parties
• Negotiate and authorize claim settlements in accordance with established standards and within the permitted level of authority
• Ask the right questions to escalate files as quickly as possible

Claims Adjuster II, Auto

• Coordinate investigations into potential fraud, misrepresentation, and/or exaggeration within Accident Benefit Claims
• Collect evidence and analyze information to determine liability and coverage, including statements, independent medical examinations, medical and employment documents, claims documents, witness testimony, police reports, and other relevant information
• Identify fraud indicators and coordinate investigative, medical, and legal resources to validate indicators and make decisions on liability and coverage
• Communicate with customers, claimants, and lawyers regarding coverage decisions, findings, and claim settlements
• Pursue fair and equitable resolutions to customer disputes, complaints, and escalations
• Participate in and/or lead projects with Investigative Services and Claims departments
• Ensure claims and investigations are clearly documented and meet legislative requirements

Claims Representative II – Accident Benefits Special Handling Unit

• Support claims customer demand through a call-center environment
• Investigate and negotiate property claims according to Aviva’s procedures and guidelines
• Confirm coverage and compile FNOL information for incoming claims
• Maintain data accuracy and issue payments to vendors, insureds, and experts
• Review facts, policies, technical reports, and estimates; value and negotiate or settle claims
• Advise and counsel customers on claim status while providing prompt customer service
• Keep related parties informed of claim status
• Complete correspondence efficiently, including Critical Path, Proof of Loss, and reservation of rights letters
• Recognize questionable claims, subrogation, and risk opportunities
• Review case law to determine liability
• Meet individually assigned Property team performance expectations and contribute to team success
• Adhere to attendance policies

National Property Claims Adjuster

• Analyze mid- and higher-level general liability claims to determine benefits due
• Ensure ongoing adjudication of claims within company standards and industry best practices
• Identify subrogation opportunities and negotiate settlements
• Gather information to determine liability exposure
• Assign reserve values and make claims payments as necessary
• Settle claims up to the designated authority level
• Assess liability and resolve claims within evaluation
• Approve and process assigned claims and manage action plans pursuant to the claim or client contract
• Communicate claim actions with claimants and clients
• Document claim files properly and ensure accurate claims coding
• Process complex lifetime medical and/or defined-period medical claims when required
• Maintain professional client relationships
• Support the organization's quality programs
• Perform other assigned duties

Claims Specialist jobs in Canada