Senior Claims Consultant
Top Benefits
About the role
The Senior Claims Consultant plays a pivotal role in managing complex and litigated claims within the Individual Life and Critical Illness insurance domain. This position requires a high level of expertise in insurance products, legal strategy, and stakeholder engagement. The consultant will assess, negotiate, and resolve disputed claims, provide strategic legal consultation, and represent the organization in litigation proceedings, ensuring fair and cost-effective outcomes.
Key Responsibilities:
- Assess, negotiate, and resolve disputed claims, including third-level appeals.
- Prepare and escalate complex cases to the Claims Committee with detailed case summaries.
- Provide consultation to Legal on litigation and pre-litigation strategies.
- Represent the company during lawsuits, including acting as a witness, participating in mediations, settlement conferences, and examinations for discovery.
- Deliver clear, strategic, and proactive legal advice on complex matters.
- Monitor and respond to regulatory inquiries and client concerns.
- Contribute to advocacy initiatives related to legal and regulatory developments.
- Identify and assess key regulatory and reputational risks.
- Conduct independent analysis to resolve strategic issues and inform decision-making.
- Prepare reports on claims trends, emerging issues, and performance metrics.
- Design and produce dashboards and ad-hoc reports to support business insights.
- Build and maintain effective relationships with internal and external stakeholders.
- Ensure alignment across teams and departments.
- Lead communication initiatives to influence behavior and deliver tailored messaging.
- Manage assigned caseload efficiently, escalating issues as needed.
- Participate in quality reviews and implement remediation strategies.
- Follow established policies, procedures, and signing authorities to mitigate operational risks.
- Deliver training and develop tools to support claims operations and compliance.
Qualifications:
- 5-10+ years of relevant experience in life and critical illness claims, with a focus on litigation.
- Strong working knowledge of Microsoft 365 products including Copilot.
- Post-secondary degree in a related field or equivalent combination of education and experience.
- Expert knowledge of insurance products, contracts, and benefit plans (individual, disability, and group).
- Strong verbal and written communication skills.
- Advanced analytical, problem-solving, and influence skills.
- Proven ability to work independently and handle non-routine situations.
- In-depth collaboration and data-driven decision-making capabilities.
About Desjardins
Desjardins Group is the largest cooperative financial group in North America and the fifth largest cooperative financial group in the world, with assets of $435.8 billion as at March 31, 2024. It was named one of Canada's Best Employers by Forbes magazine and by Mediacorp. To meet the diverse needs of its members and clients, Desjardins offers a full range of products and services to individuals and businesses through its extensive distribution network, online platforms and subsidiaries across Canada. Ranked among the world's strongest banks according to The Banker magazine, Desjardins has some of the highest capital ratios and credit ratings in the industry and the first according to Bloomberg News.
Senior Claims Consultant
Top Benefits
About the role
The Senior Claims Consultant plays a pivotal role in managing complex and litigated claims within the Individual Life and Critical Illness insurance domain. This position requires a high level of expertise in insurance products, legal strategy, and stakeholder engagement. The consultant will assess, negotiate, and resolve disputed claims, provide strategic legal consultation, and represent the organization in litigation proceedings, ensuring fair and cost-effective outcomes.
Key Responsibilities:
- Assess, negotiate, and resolve disputed claims, including third-level appeals.
- Prepare and escalate complex cases to the Claims Committee with detailed case summaries.
- Provide consultation to Legal on litigation and pre-litigation strategies.
- Represent the company during lawsuits, including acting as a witness, participating in mediations, settlement conferences, and examinations for discovery.
- Deliver clear, strategic, and proactive legal advice on complex matters.
- Monitor and respond to regulatory inquiries and client concerns.
- Contribute to advocacy initiatives related to legal and regulatory developments.
- Identify and assess key regulatory and reputational risks.
- Conduct independent analysis to resolve strategic issues and inform decision-making.
- Prepare reports on claims trends, emerging issues, and performance metrics.
- Design and produce dashboards and ad-hoc reports to support business insights.
- Build and maintain effective relationships with internal and external stakeholders.
- Ensure alignment across teams and departments.
- Lead communication initiatives to influence behavior and deliver tailored messaging.
- Manage assigned caseload efficiently, escalating issues as needed.
- Participate in quality reviews and implement remediation strategies.
- Follow established policies, procedures, and signing authorities to mitigate operational risks.
- Deliver training and develop tools to support claims operations and compliance.
Qualifications:
- 5-10+ years of relevant experience in life and critical illness claims, with a focus on litigation.
- Strong working knowledge of Microsoft 365 products including Copilot.
- Post-secondary degree in a related field or equivalent combination of education and experience.
- Expert knowledge of insurance products, contracts, and benefit plans (individual, disability, and group).
- Strong verbal and written communication skills.
- Advanced analytical, problem-solving, and influence skills.
- Proven ability to work independently and handle non-routine situations.
- In-depth collaboration and data-driven decision-making capabilities.
About Desjardins
Desjardins Group is the largest cooperative financial group in North America and the fifth largest cooperative financial group in the world, with assets of $435.8 billion as at March 31, 2024. It was named one of Canada's Best Employers by Forbes magazine and by Mediacorp. To meet the diverse needs of its members and clients, Desjardins offers a full range of products and services to individuals and businesses through its extensive distribution network, online platforms and subsidiaries across Canada. Ranked among the world's strongest banks according to The Banker magazine, Desjardins has some of the highest capital ratios and credit ratings in the industry and the first according to Bloomberg News.