About the role

Claims Specialist adjudicating Life, Critical Illness, and Disability claims for TD Insurance. Providing professional communication and analysis during claim adjudication processes.

Responsibilities

Ensure claim philosophy for TD Life and Health is administered in a consistent and cost-effective manner in accordance with TPA and vendor agreements
Co-ordinate litigation activity with external counsel and TDBFG legal department
Represent TD Life on litigation claim matters
Support creating, documenting, and implementing training and procedure manuals
Provide leadership, motivate, mentor, and develop staff in all areas of claim adjudication
Approve and decline claims over the Claim Advisors and vendor limits
Provide problem and complaint resolution on contentious claims for issues not resolved by Advisors and vendors
Monitor workflow and reports to ensure all claim service level agreements are met
Conduct Quality Assessment Reviews (QARs) for the vendor and provide feedback and recommendations based on the results

Bilingual French and English is required
Minimum Grade 12 education plus 5 years relevant insurance experience in either Individual or Group claims, or University degree or RN qualification
Solid working knowledge of Word and Excel
Solid knowledge of TD Life products
Superior interpersonal skills and ability to handle stressful situations with tact and courtesy
Must be able to contribute to a positive working environment and adapt effectively to a changing environment