Claims Adjuster - Accident Benefits

Wawanesa Insurance is one of Canada’s largest mutual insurers, and they are seeking a Claims Adjuster I for Accident Benefits. The role involves managing low to moderate complexity Accident Benefit claims, providing support to members throughout the claims process, and ensuring timely and high-quality service delivery.ResponsibilitiesGuide and support injured members throughout the claims process, delivering an empathetic and exceptional member experienceCommunicate proactively and professionally with members and stakeholders via phone, digital, and written channelsAdjust low to moderate complexity Accident Benefit claims from initial report to resolutionInterpret policy wordings, determine coverage, and clearly communicate claim decisionsEstablish and maintain accurate loss and expense reserves using medical, legal, financial, and vocational informationConduct thorough investigations to determine coverage and liability, in line with adjusting guidelines and regulatory requirementsCoordinate services with internal partners and external vendors, including medical providers, rehabilitation clinics, lawyers, and other service professionalsNegotiate and communicate claim settlements within authority limits; prepare files for arbitration and litigation as requiredMaintain organized and up‑to‑date claim files, diaries, and documentation in accordance with established procedures and the Proactive Case Management ModelInterpret policy wordings, determine coverage, and clearly communicate claim decisionsEnsure claims are adjudicated as per the Statutory Accident Benefits Schedule and legislative timelines are adhered toMaintain strong knowledge of policy coverages and remain current on legislative, regulatory, and industry changesLiaise with claimants, healthcare professionals, employers, treatment providers, and internal teams to support return‑to‑work and recovery outcomesPerform other duties as assignedSkillsMinimum 1 year of experience in insurance adjusting, medical, or brokerage environmentsWillingness to pursue the Chartered Insurance Professional (CIP) designationBasic knowledge of medical terminologyProven time management and organizational skills, with the ability to prioritize in a fast‑paced, changing environmentStrong customer service skills with a demonstrated ability to show empathy and prioritize member satisfactionExcellent verbal, written, and active listening communication skillsSound negotiation, decision‑making, and critical‑thinking skills, with a commitment to continuous improvementStrong investigative and analytical abilities, with a high level of accuracy and attention to detailStrong teamwork and collaboration skillsPost‑secondary education considered an assetBenefitsAnnual bonus planLeave of absence top-up programsGenerous vacation timePersonal daysPremium free benefitsPension planCompany OverviewWawanesa Insurance offers a breadth of insurance products. It was founded in 1896, and is headquartered in Winnipeg, Manitoba, CAN, with a workforce of 1001-5000 employees. Its website is https://www.wawanesa.com.



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