Senior Claims Examiner

Travel Requirements:
Some travel may be required

Number of Vacancies : 1
Office

Hours:

8:30AM– 4:30PM
May be required to attend off-hour’s functions/meetings
The Healthcare Insurance Reciprocal of Canada (HIROC) is a trusted healthcare safety advisor, committed to offering a full spectrum of insurance, risk and claims management products and support.
HIROC knows healthcare as it’s the largest not-for-profit healthcare liability insurer in the country, with over 700+ healthcare organizations part of the Reciprocal. Combined with sage counsel and risk management solutions, HIROC works with its partners to increase safety.
As a Reciprocal, HIROC is governed by its Subscribers and remains an innovative, agile and proactive partner. Since its inception in 1987, the not-for-profit has returned over $260 million to the healthcare system. HIROC’s 35 years of data is combined with its extensive experience to advise and share learnings, all with the goal of scaling knowledge and increasing safety across Canada’s healthcare system.
One common thread running through HIROC’s culture is the feeling of being part of something unique: partnering to create the safest healthcare system – HIROC’s vision.
Each employee has the opportunity to find their calling and help build a stronge organization designed to meet the needs of its Subscribers. As a Top 100 GTA Employer ten years running, HIROC employees are empowered to find solutions and create amazing experiences in service to its Subscribers.
Join us and be part of the team working to make a difference.

KEY RESPONSIBILITIES:

Review initial documentation, apply legal/claims analysis and set/amend reserves
Instruct adjuster/lawyer on a continuing basis, settle/deny/defend decisions
Ensure required information/evidence is collected & preserved, authorize mediation & pre-trial expenses
Conduct/control negotiations with plaintiff counsel, mediators, pre-trial judges, and claimants
Make settlement decisions up to the posted reserve of assigned claims, authorize settlement payments. Handle special-focus-area of specialty claims as assigned
Policy Interpretation
Situational Analysis & Recommendations for actions on non-claim matters
Provide advice regarding general risk management queries and/or referral to Healthcare Safety and Risk Management Department
Work with Healthcare Safety and Risk Management Department for Education and Developing Coordinated Responses to Situations
Work with Insurance Services Department for Policy Development and Revision, Education as to new legal developments
Liaise with Finance and Accounting to verify transactions
Continuous skills and knowledge upgrading (negotiation, insurance knowledge, computer abilities, legal developments, court trends, settlement amounts)
Present to HIROC Subscribers/Healthcare administrators on Insurance & Claims Matters
Other duties as assigned
KNOWLEDGE, SKILLS & ABILITIES:
High regard for quality, attention to detail and the ability to maintain confidentiality
Well organized and able to meet deadlines
Willing to demonstrate initiative
Ability to maintain a high level of accuracy
Knowledge of principles and practices of basic office procedures
Strong ability to multitask
Excellent verbal, written and oral communication skills
Advance working knowledge of the Microsoft Office suite of tools, with particular emphasis on Outlook, Word and Excel
Ability to exercise discretion and tact in sensitive and confidential situations
Well-developed analytical skills
Ability to work both independently and as a team member
Flexible in approach
Enjoys a variety of work
Ability to work and form good working relationships
Valid G driver’s licence and access to a vehicle
EDUCATION, TRAINING &

EXPERIENCE:

Completion of post-secondary education or equivalent…