Job Description

Are you looking to be part of a continually growing and dynamic company that is a leader in the life insurance industry? Canada Protection Plan, A Foresters Financial Company, is a Canadian owned and operated corporation that designs, markets and sells life insurance and related products with simplified underwriting processes that require no medical exams on many of our plans

Would you like to make a difference with the customers we serve? We are driven to excel, and our employees reflect this passion. Our company values include shared collaboration, career development and a friendly and open work environment. Canada Protection Plan offers this and more.

Our strength is a culture characterized by particular care and respect for employees. We connect with our employees in significant and meaningful ways, including (but not limited to):

• An orientation to physical, mental, and financial wellness in the workplace
• Employee development
• Performance management program which connects goal setting, coaching, formal performance reviews and the allocation of base salary and bonus rewards
• Company-paid benefit plan with a health care spending account (HCSA) as well as an RRSP and DPSP program where the company matches employee contributions
• One paid volunteer day per year to engage in a charitable cause of choice
• Free onsite parking
• Casual dress code policy

As a Member of the Claims team, the Bilingual Senior Claims Adjudicator will be accountable for ensuring that all claims are adjudicated and administered according to state and provincial law and regulations and in a fair, ethical and efficient manner.

Duties will include:

• Adjudicate various types of complex claims, including Life, Critical Illness and Accelerated Death Benefit claims. This includes identifying, collecting and reviewing all relevant information needed to determine the claim legitimacy and eligibility as well as the benefit amount payable.
• Familiarization with the requirements of the appropriate provincial/state legislation and/or regulations related to the type of claim being reviewed.
• Perform all necessary benefit calculations and ensure all related activities are in compliance with provincial/state statutory and internal standards.
• Communicate effectively with outside resources such as medical consultants, legal consultants, independent physicians, coroners, police or investigative services.
• Determine which claims need to be referred for evaluation and decision, based on authority limits, business case issues or referral to legal counsel.
• Maintain and update system records as necessary.
• Other duties as required

Knowledge/Experience/Skills:

• Bilingual (English/French) is required
• 5 – 7 years experience adjudicating complex claims, including contestable claims
• College Diploma or University Degree an asset
• Knowledge of claims adjudication theory, principles, methods, systems, processes and standards including an understanding of insurance medicine and actuarial principles/methods as they relate to the claims function
• Knowledge of the interpretation and application of claims adjudication regulations across Canada
• Self starter with demonstrated ability to prioritize case load and ability to research/problem solve and make decisions both independently and collaboratively within a fast-paced team environment
• Advanced verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors
• Strong reasoning and judgment to balance commitments, financial soundness and quality customer focus
• Strong analytical skills for research, review and assessment of claims
• LOMA/ALHC designation an asset

At Canada Protection Plan, we are committed to fostering an inclusive, accessible environment, where all employees and customers feel valued, respected and supported. We are dedicated to building a diverse workforce and we are an equal opportunity employer.

If you require an accommodation, Canada Protection Plan will provide reasonable accommodations, accessible formats and communication supports upon request to all candidates with disabilities who take part in all aspects of the recruitment and selection process.


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