Workers Compensation Claims Representative managing claims independently with minimal oversight. Conducting thorough investigations and negotiating settlements for insured parties in a hybrid work environment.
About the role
- Multiline Claims Specialist investigating and resolving multiline insurance claims with a focus on member satisfaction. Collaborating with internal and external stakeholders within a hybrid work environment.
Responsibilities
- Investigate and evaluate claims across multiple lines of business (property, auto, and liability)
- Review claim documentation, policy wording, endorsements, and supporting evidence to confirm eligibility and compliance
- Communicate with claimants, insureds, witnesses, brokers, and third parties to gather required information and explain claims processes and decisions
- Negotiate settlements in accordance with policy provisions and delegated authority
- Identify claims requiring escalation, litigation, or external expertise and provide recommendations to management and legal counsel
- Participate in litigation support activities, including file preparation, consultations with counsel, and attendance at hearings where required
- Handle Property, Liability, Accident Benefits and Bodily Injury claims as required
- Provide technical guidance and interpretation of policy coverage, exclusions, and conditions to ensure consistent claims handling
- Review and analyze complex or escalated claims files to ensure adherence to internal standards, regulatory requirements, and best practices
- Support consistency in reserving practices and submit claim liability information to actuarial or leadership teams as required
- Assist in resolving claims-related complaints and appeals requiring advanced technical review
- Act as a resource for staff on coverage interpretation and adjusting practices, including property, auto, and liability claims
- Review claims processes, procedures, and workflows to identify opportunities for efficiency, accuracy, and quality improvement
- Ensure claims handling aligns with company policies, procedures, and applicable legislation and regulatory standards
- Prepare reports and analyze claims data to support monitoring, quality assurance, and management decision-making
- Contribute to training initiatives, documentation, and knowledge sharing related to complex claims handling and policy interpretation
Requirements
- Post-secondary education in insurance, business, or a related field
- Minimum 5–7 years of progressive experience in multiline insurance claims
- Strong technical knowledge of insurance policy wording, coverage analysis, liability determination, and claims reserving
- Experience handling complex, high-value, or escalated claims and supporting litigation-related activities
- Familiarity with Ontario insurance legislation, regulatory requirements, and industry best practices
- Knowledge of Ontario insurance legislation across multiple lines of business, including Property, Auto, Liability, and Accident Benefits
- Professional insurance designation (e.g., CIP, FCIP, or working toward) is strongly preferred
- Excellent analytical, communication, and negotiation skills
Benefits
- Health insurance
- Professional development opportunities
- Paid time off
- Flexible work arrangements
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