Accident Benefits Claims Representative - ll
Edmonton, Alberta, Canada
Full Time
1 day ago
$64,000 - $80,000 CAD
Key skills
AIArtificial IntelligenceCommunicationDecision MakingCritical Thinking
About this role
About Portage Mutual: Where Your Talent Makes a Difference
Imagine a workplace where your contributions are not only valued but also directly impact the lives of Canadians. At Portage Mutual Insurance, we’re more than just a trusted national property and casualty insurer—we’re a community of passionate individuals dedicated to serving our policyholders since 1884. Owned by our policyholders, we proudly offer competitive home, auto, commercial, and farm insurance products 100% through our broker network across Canada. Join a company rooted in tradition, driven by innovation, and powered by a people-first culture.
Why Portage Mutual?
At Portage Mutual, we believe that our people are our greatest asset. Here, you’ll find:
• Total Rewards: We care about your well-being and financial security. That’s why we offer a competitive salary, incentive plan, comprehensive health benefits, a pension plan and generous paid time off, including personal days.
• Career Growth & Development: Propel your career forward with access to diverse learning resources, tuition reimbursement for relevant programs, and bonuses recognizing your achievements in pursuing insurance designations.
• Flexibility: We support work-life integration by offering a flexible environment where you can choose to live wherever you prefer in Canada. Enjoy the freedom to select remote, in-office, and hybrid work arrangements that best suit your lifestyle.
• Inclusivity and Belonging: Be a part of a supportive and diverse team that embraces your unique perspective and empowers you to succeed. We’re dedicated to creating a workplace where every employee feels welcomed, valued and respected.
• Making a Difference: Find purpose in your career by aligning with an organization that shares your values and is committed to making a difference in the communities we serve.
The Opportunity: Accident Benefits Claims Representative II
As an Intermediate Accident Benefits Claims Representative, you’ll investigate, evaluate, reserve, negotiate and resolve assigned automobile accident benefits claims by:
• Reviewing new losses, developing investigation plans, gathering statements, obtaining necessary documentation (medical records, authorizations, forms), and applying regulatory classifications accurately.
• Communicating with policyholders, treatment providers, investigators, accountants, and medical professionals to assess injuries, financial losses, and determine claim eligibility.
• Utilizing systems like HCAI, applying dispute resolution techniques, and leveraging structured settlements and independent medical exams to ensure fair and timely claim outcomes.
We're looking for a detail-oriented, enthusiastic team player who embodies our company values and is committed to providing top-notch service.
What You’ll Do:
• Review new losses, prepare an investigation plan, and contact the insured to discuss loss details.
• Work with policyholders to explain claims process in a clear and concise manner to ensure an efficient claims experience.
• Secure statements with policyholders, third parties, independent witnesses, passengers as necessary.
• Secure medical authorization, statutorily required forms, and medical opinions as necessary.
• Arrange appropriate independent medical examinations to aid in the assessment of coverage, injuries and damages.
• Asses the need and retain licensed investigators to assist in understanding injury severity.
• Work with accountants to asses income and other financial losses related to accident benefit coverages.
• Review complex policy wordings and legislation to assess coverage eligibility.
• Communicate verbally and in writing to policyholders and brokers coverage positions.
• Review complex medical forms and reports to determine benefit payment eligibility.
• Negotiate settlements based on results of loss investigation, coverage analysis and damage assessment within authority limits.
• Complete ongoing follow up communication per corporate service standards with all file stakeholders to bring claim to resolution.
• Attend industry events to network with brokers and vendors in a manner that portrays Portage Mutual Insurance in a positive light.
What You’ll Bring:
• Minimum of 3-5 years experience with auto physical damage adjusting, in a medical professional office, and in a role dealing with accident benefit claims.
• Proficient in Microsoft Office Suite and relevant claims systems (e.g., Guidewire), with the ability to adapt to new technologies.
• Consistently applies accuracy, thoroughness, and meticulousness in all aspects of work.
• Strong critical thinking and problem-solving skills to assess the strengths and weaknesses of each claim within authority limits.
• Excellent verbal and written communication skills.
• High level of confidentiality.
• Ability to work independently or as a collaborative team and is self-motivated to work in a fast-paced changing environment.
• Post secondary education in business, nursing, health care aid, insurance or medical reception.
• CIP designation completed, actively in progress, or willing to work towards.
This hybrid position is based in Edmonton, Alberta in-office 2–3 days per week.
The targeted pay range for this position in the following location is / locations are:
Canada – Alberta: $64,000 - $80,000 CAD / Annual
Our pay ranges reflect the minimum and maximum target for new hire pay for the full-time position determined by role and level. The pay range shown is based on our compensation structure in place at the time of posting and may be updated periodically based on business needs. Individual pay is based on additional factors including job-related skills, experience, and relevant education and/or training.
Portage Mutual uses artificial intelligence and automations in its recruitment practices for activities that may include searching for qualified candidates, screening applications, preparing interview questions, recording interviews, drafting transcripts and other administrative tasks. AI is never used for decision making purposes.
Ready to Make an Impact?
If you’re seeking a rewarding career with a company that values its employees and is committed to making a difference, we invite you to apply! If you have the qualifications we are seeking and would thrive in a work environment where you are valued and respected, please apply!
Portage Mutual Insurance is committed to providing accommodations for people with disabilities during all phases of the recruiting process, including the application process. If you require accommodation because of a disability, we will work with you to meet your needs. If you are selected for an interview and require accommodation, please advise the HR representative who will consult with you to determine an appropriate accommodation.
Please submit your resume and cover letter!
We thank you for your interest in Portage Mutual Insurance, however, only those selected for an interview will be contacted. (No agencies please).
Imagine a workplace where your contributions are not only valued but also directly impact the lives of Canadians. At Portage Mutual Insurance, we’re more than just a trusted national property and casualty insurer—we’re a community of passionate individuals dedicated to serving our policyholders since 1884. Owned by our policyholders, we proudly offer competitive home, auto, commercial, and farm insurance products 100% through our broker network across Canada. Join a company rooted in tradition, driven by innovation, and powered by a people-first culture.
Why Portage Mutual?
At Portage Mutual, we believe that our people are our greatest asset. Here, you’ll find:
• Total Rewards: We care about your well-being and financial security. That’s why we offer a competitive salary, incentive plan, comprehensive health benefits, a pension plan and generous paid time off, including personal days.
• Career Growth & Development: Propel your career forward with access to diverse learning resources, tuition reimbursement for relevant programs, and bonuses recognizing your achievements in pursuing insurance designations.
• Flexibility: We support work-life integration by offering a flexible environment where you can choose to live wherever you prefer in Canada. Enjoy the freedom to select remote, in-office, and hybrid work arrangements that best suit your lifestyle.
• Inclusivity and Belonging: Be a part of a supportive and diverse team that embraces your unique perspective and empowers you to succeed. We’re dedicated to creating a workplace where every employee feels welcomed, valued and respected.
• Making a Difference: Find purpose in your career by aligning with an organization that shares your values and is committed to making a difference in the communities we serve.
The Opportunity: Accident Benefits Claims Representative II
As an Intermediate Accident Benefits Claims Representative, you’ll investigate, evaluate, reserve, negotiate and resolve assigned automobile accident benefits claims by:
• Reviewing new losses, developing investigation plans, gathering statements, obtaining necessary documentation (medical records, authorizations, forms), and applying regulatory classifications accurately.
• Communicating with policyholders, treatment providers, investigators, accountants, and medical professionals to assess injuries, financial losses, and determine claim eligibility.
• Utilizing systems like HCAI, applying dispute resolution techniques, and leveraging structured settlements and independent medical exams to ensure fair and timely claim outcomes.
We're looking for a detail-oriented, enthusiastic team player who embodies our company values and is committed to providing top-notch service.
What You’ll Do:
• Review new losses, prepare an investigation plan, and contact the insured to discuss loss details.
• Work with policyholders to explain claims process in a clear and concise manner to ensure an efficient claims experience.
• Secure statements with policyholders, third parties, independent witnesses, passengers as necessary.
• Secure medical authorization, statutorily required forms, and medical opinions as necessary.
• Arrange appropriate independent medical examinations to aid in the assessment of coverage, injuries and damages.
• Asses the need and retain licensed investigators to assist in understanding injury severity.
• Work with accountants to asses income and other financial losses related to accident benefit coverages.
• Review complex policy wordings and legislation to assess coverage eligibility.
• Communicate verbally and in writing to policyholders and brokers coverage positions.
• Review complex medical forms and reports to determine benefit payment eligibility.
• Negotiate settlements based on results of loss investigation, coverage analysis and damage assessment within authority limits.
• Complete ongoing follow up communication per corporate service standards with all file stakeholders to bring claim to resolution.
• Attend industry events to network with brokers and vendors in a manner that portrays Portage Mutual Insurance in a positive light.
What You’ll Bring:
• Minimum of 3-5 years experience with auto physical damage adjusting, in a medical professional office, and in a role dealing with accident benefit claims.
• Proficient in Microsoft Office Suite and relevant claims systems (e.g., Guidewire), with the ability to adapt to new technologies.
• Consistently applies accuracy, thoroughness, and meticulousness in all aspects of work.
• Strong critical thinking and problem-solving skills to assess the strengths and weaknesses of each claim within authority limits.
• Excellent verbal and written communication skills.
• High level of confidentiality.
• Ability to work independently or as a collaborative team and is self-motivated to work in a fast-paced changing environment.
• Post secondary education in business, nursing, health care aid, insurance or medical reception.
• CIP designation completed, actively in progress, or willing to work towards.
This hybrid position is based in Edmonton, Alberta in-office 2–3 days per week.
The targeted pay range for this position in the following location is / locations are:
Canada – Alberta: $64,000 - $80,000 CAD / Annual
Our pay ranges reflect the minimum and maximum target for new hire pay for the full-time position determined by role and level. The pay range shown is based on our compensation structure in place at the time of posting and may be updated periodically based on business needs. Individual pay is based on additional factors including job-related skills, experience, and relevant education and/or training.
Portage Mutual uses artificial intelligence and automations in its recruitment practices for activities that may include searching for qualified candidates, screening applications, preparing interview questions, recording interviews, drafting transcripts and other administrative tasks. AI is never used for decision making purposes.
Ready to Make an Impact?
If you’re seeking a rewarding career with a company that values its employees and is committed to making a difference, we invite you to apply! If you have the qualifications we are seeking and would thrive in a work environment where you are valued and respected, please apply!
Portage Mutual Insurance is committed to providing accommodations for people with disabilities during all phases of the recruiting process, including the application process. If you require accommodation because of a disability, we will work with you to meet your needs. If you are selected for an interview and require accommodation, please advise the HR representative who will consult with you to determine an appropriate accommodation.
Please submit your resume and cover letter!
We thank you for your interest in Portage Mutual Insurance, however, only those selected for an interview will be contacted. (No agencies please).