Intermediate Claims Exmainer
POSITION TITLE: Intermediate Claims Examiner
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 $200 million to the healthcare system. HIROC’s thirty-plus 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 five 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.
- 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 Risk Management department
- Work with Healthcare Risk Management Department for Education and Developing Coordinated Responses to Situations
- Work with Insurance Operations 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)
- Assist with training of new claims examiners and admin staff
- Present to HIROC Subscribers/Healthcare administrators on Insurance & Claims Matters
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 Ontario G drivers license and access to a vehicle
EDUCATION, TRAINING & EXPERIENCE:
- Minimum of 2 years University Education
- Completion of CIP and completion or enrolment in FCIP and/or CRM required courses
- Minimum of 5 years of working experience with claims processing activity or equivalent responsibility
- Most importantly, you are an enthusiastic and creative thinker, who is constantly driving performance improvement and are passionate about creating the safest health care system possible for Canadians.
- Hybrid work model – 2-3 times a week in office
- Working at a computer for much of the day
- Travel across Canada is 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 providing a barrier-free environment for all stakeholders, including our subscribers, employees, job applicants, suppliers, the public and any visitors who may enter our premises, access our information, or use our services. As an organization, we respect and uphold the requirements set forth under the Accessibility for Ontarians with Disabilities Act (AODA) and its associated standards and regulations and will ensure that we offer a safe and welcoming environment that is respectful of each person's dignity and independence.
As an organization, HIROC is dedicated to meeting the needs of individuals with disabilities in a timely manner. We understand that providing a barrier-free environment is a shared effort, and as an organization, we are committed to working with the necessary parties to make accessibility a reality for all.
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