Job Description

SENIOR CLAIMS EXAMINER

Job Title : Senior Claims Examiner

Reports to: Lead, Claims Support

Status: Full-Time Permanent

Direct Reports: None

Travel Requirements: Some travel may be required

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 stronger organization designed to meet the needs of its Subscribers. As a Top 100 GTA Employer nine 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)
• Train junior staff
• 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
• Excellent time management skills
• 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 work experience
• Minimum of 8-10 years of working experience with claims processing activity or equivalent responsibility
• Enrollment in or completion of CIP, FCIP and/or CRM required courses
• Experience with Property and Professional Liability (Medical Malpractice) claims preferred
• Most importantly, you are an enthusiastic and creative thinker, who is constantly driving performance improvement and are passionate about creating the safest healthcare system possible for Canadians.

HOURS OF WORK:

• Monday-Friday 8:30am-4:30pm
• May be required to attend off hour’s functions/meetings

WORKING CONDITIONS:

• Hybrid work model
• Working at a computer for most of the day
• Some travel may be required

TO APPLY: Please submit your résumé to HR@hiroc.com

In order to be considered for this position, please include a current résumé or detailed qualifications summary with your application. Only those selected for an interview will be contacted.

HIROC is committed to fostering a climate of equity, diversity, inclusion, and accessibility. HIROC respects the diversity of all members of its community and welcomes applications from those who have demonstrated a commitment to the values of equity, diversity and inclusion. Applications from members of groups that have been historically disadvantaged and marginalized, including First Nations, Métis and Inuit peoples, racialized persons, persons with disabilities, those who identify as women, 2SLGBTQ+, individuals who self-identify on the basis of any of the protected grounds under the Human Rights Code and/or others who may contribute to the further diversification of ideas within its community are encouraged. HIROC is committed to fair assessment of a candidate’s abilities, and consideration for diversity of thought, method, and experience, including non-traditional career paths.

HIROC is committed to providing a barrier-free environment for all stakeholders, including its participants, employees, job applicants, suppliers, the public and any visitors who may enter its premises, access its information, or use its services. As an organization, HIROC respects and upholds the requirements set forth under the Accessibility for Ontarians with Disabilities Act (AODA) and its associated standards and regulations and will ensure that HIROC offers a safe and welcoming environment that is respectful of each person's dignity and independence.

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