Claims Processor evaluating and processing pet insurance claims for Pets Plus Us across Canada. Reviewing veterinary histories, policy eligibility, coverage, and compensation decisions.
About the role
- Claims Specialist responsible for guiding customers through the claims process at Zurich Canada. Managing low to moderate complexity personal lines auto claims primarily through phone interactions.
Responsibilities
- Document claims file by accurately capturing and updating claims data/information in compliance with best practices for low to moderate exposure and complexity personal lines claims.
- Exercise judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
- Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
- Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.
- Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
- Assess damages by calculating applicable damages or range of damages allowed by law.
- Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
- Meet quality standards by following best practices.
- Ensure customer service by proactively communicating information; responding to inquiries; following customer protocols and may participating in customer marketing efforts.
- Manage expenses by working within vendor approved networks and managing scope of work assigned to outside contractors. Departs from approved vendors with manager approval, where in the best interests of the insured.
- Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
- Refer claim to subrogation and fraud teams by identifying potential subrogation and fraud.
- Contribute to profitable growth by providing risk insight, information and trends to Business Unit or customer as needed.
- Protect Zurich’s reputation by keeping claims information confidential.
- Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks, and participating in professional societies.
Requirements
- Bachelor’s Degree and 2 or more years of experience in the Claims or Insurance area OR
- Zurich Certified Insurance Apprentice including an Associate Degree and 2 or more years of experience in the Claims or Insurance area OR
- High School Diploma or Equivalent and 4 or more years of experience in the Claims or Insurance area OR
- Completion of Zurich Claims Training Program and 1 or more years of experience in the Claims or Insurance area AND
- Microsoft Office experience
- Knowledge of insurance regulations, markets and products
- Prior experience in auto claims handling, insurance claims, or a related customer service field. Understanding of auto insurance policies, coverage, and regulations.
Benefits
- Comprehensive health/benefits plan with varying levels of coverage
- Minimum of four weeks of vacation per year
- Four personal days per year
- Access to a comprehensive range of training and development opportunities
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