Senior Claims Advisor- Accident Benefits

Cambridge3w ago

Seniority: Senior

About the role

<div class="content-intro">  At Gore Mutual, we’ve always set ourselves apart as a modern mutual that does good. Now, we’re proudly building on that legacy to transform our company—and our industry—for the better. Effective January 1, 2026, Gore has joined Beneva—the country’s largest mutual insurance company—as part of its Property & Casualty operations in Ontario and Western Canada. During 2026, Gore will combine its operations with Unica Insurance, Beneva’s Ontario-based subsidiary specializing in niche commercial and personal insurance, creating a stronger, more diversified mutual insurer with greater scale and long-term stability. Every decision and investment remains anchored in long-term benefits to customers, members, and communities. Come join us.</div>2 Vacancies  An Accident Benefits (AB) adjuster is responsible for evaluating the validity of claims and guiding claimants through the insurance process. They assess the extent of coverage under the policy, ensuring all necessary documentation is completed and submitted. Acting as the main point of contact, they address any questions or concerns from claimants, providing clear explanations of coverages, deductibles, and the steps involved in the claims process. They process claims promptly and fairly, adhering to legal and regulatory requirements set by the Financial Services Regulatory Authority of Ontario (FSRA). They are expected to act in good faith, avoiding unreasonable denial of benefits and ensuring compliance with all relevant laws and regulations. The AB Senior role is responsible for investigating, evaluating, reserving, negotiating, medically managing and settling MIG and Non-Catastrophic AB claims of moderate complexity and value (IRB, Non-Earner/Priority loss transfers within authority). They also serve as formal and informal mentors to our Med Desk adjusting Team.  What will you do?  <ul> <li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="1" data-aria-level="1">Reviewing, investigating and documenting medical reports and claim-related information and the appropriate setting of AB Claims reserves. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="2" data-aria-level="1">Negotiation and Settlement of claims of moderate complexity. </li> </ul> <ul> <li data-leveltext="o" data-font="Courier New" data-listid="1" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="1" data-aria-level="2">This occasionally includes preparing and presenting files for authority or strategic approval as well as attending hearings or case conferences. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="3" data-aria-level="1">Direct communications with claimants/guardians (phone or written) for medically managed claim files. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="4" data-aria-level="1">Communication between internal and external legal counsel, case managers, and outside vendors. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="5" data-aria-level="1">Coaching and mentoring Med Desk Team. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="1" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="6" data-aria-level="1">Invoicing and administrative tasks. </li> </ul> What will you need to succeed?  <ul> <li data-leveltext="" data-font="Symbol" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="1" data-aria-level="1">Post Secondary Education: Typically a relevant degree/diploma in insurance or a related field. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="2" data-aria-level="1">Work Experience: </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="3" data-aria-level="1">5 years of AB Claims Handling experience strongly preferred </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="4" data-aria-level="1">Exposure to LAT Handling process. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="5" data-aria-level="1">Capable dispute resolution. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="6" data-aria-level="1">Some litigation management for AB. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="7" data-aria-level="1">Experience attending and achieving desirable file resolutions through Settlement Conferences. </li> </ul> <ul> <li data-leveltext="" data-font="Symbol" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":720,"335559991":360,"469769226":"Symbol","469769242":[8226],"469777803":"left","469777804":"","469777815":"multilevel"}" data-aria-posinset="8" data-aria-level="1">Opportunities for internal promotion based on performance and potential. </li> </ul> Skills:  <ul> <li data-leveltext="o" data-font="Courier New" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="1" data-aria-level="2">Effective Communication. </li> </ul> <ul> <li data-leveltext="o" data-font="Courier New" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="2" data-aria-level="2">Critical Judgement and Decision Making. </li> </ul> <ul> <li data-leveltext="o" data-font="Courier New" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="3" data-aria-level="2">Resilience. </li> </ul> <ul> <li data-leveltext="o" data-font="Courier New" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="4" data-aria-level="2">Attention to Detail. </li> </ul> <ul> <li data-leveltext="o" data-font="Courier New" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="5" data-aria-level="2">Claims Negotiation and Settlement. </li> </ul> <ul> <li data-leveltext="o" data-font="Courier New" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="6" data-aria-level="2">Assessment and interpretation of medical reports and injuries. </li> </ul> <ul> <li data-leveltext="o" data-font="Courier New" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="7" data-aria-level="2">Claims Evaluation and Investigation. </li> </ul> <ul> <li data-leveltext="o" data-font="Courier New" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="8" data-aria-level="2">Dispute and Litigation Management for AB Ontario. </li> </ul> <ul> <li data-leveltext="o" data-font="Courier New" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="9" data-aria-level="2">Advanced understanding of SABS. </li> </ul> <ul> <li data-leveltext="o" data-font="Courier New" data-listid="2" data-list-defn-props="{"335552541":1,"335559685":1440,"335559991":360,"469769226":"Courier New","469769242":[9675],"469777803":"left","469777804":"o","469777815":"multilevel"}" data-aria-posinset="10" data-aria-level="2">Mentoring. </li> </ul> Location:  We’re a hybrid team that thrives on the energy and value of in-office collaboration. This role offers the best of both worlds, with  2 days a week spent in our vibrant office in Cambridge, Ontario   Gore Mutual Insurance is committed to providing accommodations for people with disabilities during all phases of the recruiting process, including the application process. If you require accommodation, please let us know.  The expected base salary range for this position is $56,000 - $103,500. Depending on your relevant experience, skills, qualifications, market conditions and business needs, base compensation may vary. You have the potential to earn more through Gore Mutual’s discretionary bonus program which gives you an opportunity to increase your total compensation, provided the business meets its performance targets and you meet your individual goals. Please note: This range reflects the expected base salary for this role but may not represent the full compensation range for all experience and skill levels. During the recruitment process, we will discuss and consider how your unique qualifications align with the broader range for this position. #INDHP #LI-HYBRID<div class="content-conclusion">This posting pertains to an existing vacancy that is actively being filled.   Accessibility for applicants Gore Mutual Insurance Company is committed to providing accommodations for people with disabilities during all phases of the recruiting process, including the application process. If you require accommodation because of a disability, we will work with you to meet your needs. <a href="mailto:accessibility@goremutual.ca">Contact us</a> and a human resources representative will consult with you to determine an appropriate accommodation. Should you request an accommodation during the interview process, please notify your Talent Acquisition Consultant.</div>

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