The Risk Management and Insurance Services Branch is seeking an experienced bilingual Statutory Accident Benefits claims examiner to conduct and lead the negotiation and settlement of accident benefit claims and third-party bodily injury claims made against the Motor Vehicle Accident Claims Fund (MVACF).
What can I expect to do in this role?
In this role, you will:
• examine and provide technical expertise for an active and complex accident benefit portfolio (Minor Injury Guideline (MIG), Non-Catastrophic (Non-CAT), and Catastrophic (CAT) claims), including priority investigation of claims, dispute between insurers, and third-party bodily injury claims
• conduct/lead the negotiation/settlement of complex accident benefits and third-party bodily injury claims
• provide technical advice and guidance to stakeholders, ministry program areas/legal counsel on insurance coverage issues, claims handling standards, protocols and process, mediation/litigation
• assess reserves and financial impact of claims as required by the program
• develop case management strategies/plans, participate in file audits, and projects for the research, development and implementation of new/revised claims policies
• provide analytical reports, recommendations, briefing notes and advice to senior staff and management
How do I qualify?
Mandatory
• You must possess oral and written French language skills at the advanced level. Your proficiency level will be confirmed before hire.
Specialized Knowledge
• You have demonstrated experience investigating and examining complex Accident Benefits claims (example: MIG, Non-CAT, CAT) and bodily injury claims
• You have strong knowledge of tribunals and arbitration techniques, claims handling protocols and procedures to provide technical expertise in support of the claims management program
• You have solid and extensive experience in the negotiation and settlement of complex accident benefits and personal injury claims
• You have experience in interpreting and applying the Statutory Accident Benefits Schedule, the Insurance Act, and familiarity with the Motor Vehicle Accident Claims Act
• You have experience in investigation and settlement of disputes between insurers claims in accordance with relevant legislation
• You have knowledge of auditing and risk management assessment practices to lead and report on file audits
• You have demonstrated knowledge of industry standards and best practices of automobile insurance administration
Negotiation, Consultation and Customer Service Skills
• You have experience in negotiation, mediation, arbitration, pre-trials, and other legal proceedings
• You have influencing and customer service skills to interact with third-party adjusters, legal counsel and the public in the investigation and resolution of claims
• You have proven consultation and advisory skills to provide expert advice and assistance on statutory accident benefits claims entitlements, reserving and coverage interpretations and the impact of legislation on claims
Analytical, Research and Problem-Solving Skills
• You have experience in investigation, research and assessment of complex accident benefit and liability claims and calculation and analysis of claims financial exposure
• You have demonstrated research skills to research existing case law, statutes and assess trends of recent court decisions, and accurately evaluate/identify the province's exposure and changes in case law
• You are able to conduct compliance and effectiveness audits of claims handling by third-party adjusters
Communication Skills
• You have proven oral and written communication skills to negotiate settlements, conduct and participate in mediations, arbitrations and hearings
• You are able to prepare reports, correspondence and briefing notes, and respond to a range of queries
Other Essential Skills
• You have proven mathematical skills to calculate financial exposure and assess reserves
• You are proficient with computer applications to research and prepare materials and use program related software (example: claims management system)
OPS Commitment to diversity, inclusion, accessibility, and anti- racism:
We are committed to build a workforce that reflects the communities we serve and to promote a diverse, anti-racist, inclusive, accessible, merit-based, respectful and equitable workplace.
We invite all interested individuals to apply and encourage applications from people with disabilities, Indigenous, Black, and racialized individuals, as well as people from a diversity of ethnic and cultural origins, sexual orientations, gender identities and expressions.
Visit the
OPS Anti-Racism Policy and the
OPS Diversity and Inclusion Blueprint pages to learn more about the OPS commitment to advance racial equity, accessibility, diversity, and inclusion in the public service.
We offer employment accommodation across the recruitment process and all aspects of employment consistent with the requirements of Ontario's
Human Rights Code. Refer to the application instructions below if you require a disability-related accommodation.
