Senior Claims Advisor AB

📋 Description

• • Investigate moderately complex, unrepresented accident benefit claims including MIG and non-MIG first-party injury claims on a rotational basis.
• • Take ownership of pending claim files for Accident Benefit Claim Advisors requiring support, ensuring timely resolution and documentation.
• • Interpret insurance policy wording to determine coverage applicability and accurately set reserves for accident benefit claims.
• • Investigate, negotiate, and settle complex accident benefit claims via telephone and written correspondence in compliance with Ontario regulations.
• • Adhere strictly to Allstate’s policies, procedures, and legislative requirements including the Ontario Statutory Accident Benefits Schedule.
• • Ensure complete and accurate file documentation for all claims handled, maintaining audit-ready records.
• • Settle claims within personal authority limits and escalate matters exceeding authority according to company guidelines.
• • Communicate professionally with claimants, medical professionals, lawyers, and third-party vendors to resolve claims efficiently.
• • Apply critical thinking to assess strengths and weaknesses of claims, identifying potential fraud or coverage issues.
• • Manage time effectively in a fast-paced environment while maintaining high standards of file quality and customer service.
• • Collaborate with Accident Benefit Adjusters and Claims Assistants to ensure seamless claim handling and team support.
• • Set and uphold customer service expectations by taking ownership of customer problems and delivering solutions.
• • Maintain compliance with all regulatory and legislative standards governing accident benefits in Ontario and other eligible provinces.
• • Utilize strong written and verbal communication skills to convey claim decisions and next steps clearly to all stakeholders.
• • Support team objectives by rotating responsibilities to assist Accident Benefit Claim Advisors in high-volume or complex claim scenarios.
• • Apply knowledge of fraud investigation techniques and information collection methods to validate claim details and prevent improper payments.
• • Demonstrate detail-oriented approach to ensure accuracy in claim assessments, reserve setting, and settlement documentation.
• • Contribute to a culture of accountability, flexibility, and community as outlined in Allstate’s Employee Value Proposition.