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.

Responsibilities

• Guide and support injured members throughout the claims process, delivering an empathetic and exceptional member experience
• Communicate proactively and professionally with members and stakeholders via phone, digital, and written channels
• Adjust low to moderate complexity Accident Benefit claims from initial report to resolution
• Interpret policy wordings, determine coverage, and clearly communicate claim decisions
• Establish and maintain accurate loss and expense reserves using medical, legal, financial, and vocational information
• Conduct thorough investigations to determine coverage and liability, in line with adjusting guidelines and regulatory requirements
• Coordinate services with internal partners and external vendors, including medical providers, rehabilitation clinics, lawyers, and other service professionals
• Negotiate and communicate claim settlements within authority limits; prepare files for arbitration and litigation as required
• Maintain organized and up‑to‑date claim files, diaries, and documentation in accordance with established procedures and the Proactive Case Management Model
• Interpret policy wordings, determine coverage, and clearly communicate claim decisions
• Ensure claims are adjudicated as per the Statutory Accident Benefits Schedule and legislative timelines are adhered to
• Maintain strong knowledge of policy coverages and remain current on legislative, regulatory, and industry changes
• Liaise with claimants, healthcare professionals, employers, treatment providers, and internal teams to support return‑to‑work and recovery outcomes
• Perform other duties as assigned

Skills

• Minimum 1 year of experience in insurance adjusting, medical, or brokerage environments
• Willingness to pursue the Chartered Insurance Professional (CIP) designation
• Basic knowledge of medical terminology
• Proven time management and organizational skills, with the ability to prioritize in a fast‑paced, changing environment
• Strong customer service skills with a demonstrated ability to show empathy and prioritize member satisfaction
• Excellent verbal, written, and active listening communication skills
• Sound negotiation, decision‑making, and critical‑thinking skills, with a commitment to continuous improvement
• Strong investigative and analytical abilities, with a high level of accuracy and attention to detail
• Strong teamwork and collaboration skills
• Post‑secondary education considered an asset

Benefits

• Annual bonus plan
• Leave of absence top-up programs
• Generous vacation time
• Personal days
• Premium free benefits
• Pension plan

Company Overview