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GORE MUTUAL INSURANCE COMPANY logo

Senior Claims Advisor- Accident Benefits

Hybrid
Kitchener, ON
CA$56,000 - CA$103,500/annual
Senior Level

About the role

At Gore Mutual, we've always set ourselves apart as a modern mutual that does good. Now, we're proudly building on that legacy to transform our company—and our industry—for the better.

Effective January 1, 2026, Gore has joined Beneva—the country's largest mutual insurance company—as part of its Property & Casualty operations in Ontario and Western Canada. During 2026, Gore will combine its operations with Unica Insurance, Beneva's Ontario-based subsidiary specializing in niche commercial and personal insurance, creating a stronger, more diversified mutual insurer with greater scale and long-term stability.

Every decision and investment remains anchored in long-term benefits to customers, members, and communities. Come join us.

2 Vacancies

An Accident Benefits (AB) adjuster is responsible for evaluating the validity of claims and guiding claimants through the insurance process. They assess the extent of coverage under the policy, ensuring all necessary documentation is completed and submitted. Acting as the main point of contact, they address any questions or concerns from claimants, providing clear explanations of coverages, deductibles, and the steps involved in the claims process. They process claims promptly and fairly, adhering to legal and regulatory requirements set by the Financial Services Regulatory Authority of Ontario (FSRA). They are expected to act in good faith, avoiding unreasonable denial of benefits and ensuring compliance with all relevant laws and regulations. The AB Senior role is responsible for investigating, evaluating, reserving, negotiating, medically managing and settling MIG and Non-Catastrophic AB claims of moderate complexity and value (IRB, Non-Earner/Priority loss transfers within authority). They also serve as formal and informal mentors to our Med Desk adjusting Team.

What will you do?

  • Reviewing, investigating and documenting medical reports and claim-related information and the appropriate setting of AB Claims reserves.

  • Negotiation and Settlement of claims of moderate complexity.

  • This occasionally includes preparing and presenting files for authority or strategic approval as well as attending hearings or case conferences.

  • Direct communications with claimants/guardians (phone or written) for medically managed claim files.

  • Communication between internal and external legal counsel, case managers, and outside vendors.

  • Coaching and mentoring Med Desk Team.

  • Invoicing and administrative tasks.

What will you need to succeed?

  • Post Secondary Education: Typically a relevant degree/diploma in insurance or a related field.

  • Work Experience:

  • 5 years of AB Claims Handling experience strongly preferred

  • Exposure to LAT Handling process.

  • Capable dispute resolution.

  • Some litigation management for AB.

  • Experience attending and achieving desirable file resolutions through Settlement Conferences.

  • Opportunities for internal promotion based on performance and potential.

Skills:

  • Effective Communication.

  • Critical Judgement and Decision Making.

  • Resilience.

  • Attention to Detail.

  • Claims Negotiation and Settlement.

  • Assessment and interpretation of medical reports and injuries.

  • Claims Evaluation and Investigation.

  • Dispute and Litigation Management for AB Ontario.

  • Advanced understanding of SABS.

  • Mentoring.

Location: We're a hybrid team that thrives on the energy and value of in-office collaboration. This role offers the best of both worlds, with 2 days a week spent in our vibrant office in Cambridge, Ontario

Gore 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, please let us know.

The expected base salary range for this position is $56,000 - $103,500. Depending on your relevant experience, skills, qualifications, market conditions and business needs, base compensation may vary. You have the potential to earn more through Gore Mutual's discretionary bonus program which gives you an opportunity to increase your total compensation, provided the business meets its performance targets and you meet your individual goals.

Please note: This range reflects the expected base salary for this role but may not represent the full compensation range for all experience and skill levels. During the recruitment process, we will discuss and consider how your unique qualifications align with the broader range for this position.

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This posting pertains to an existing vacancy that is actively being filled.

Accessibility for applicants

Gore Mutual Insurance Company 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. Contact us and a human resources representative will consult with you to determine an appropriate accommodation.

Should you request an accommodation during the interview process, please notify your Talent Acquisition Consultant.

About GORE MUTUAL INSURANCE COMPANY

Insurance
201-500

It's no secret we love our job. We have the privilege of watching entrepreneurial ideas come to life; the privilege of serving generations of families as they grow. Gore Mutual is there along the way to offer help when you need it. And we're there to give back so your community becomes a better place to live. Through the Gore Mutual Foundation, we are proud to support many organizations. Like we said - we love our job.

The insurance industry is changing at an exponential pace, driven by changing customer experience, climate change and technology. In response Gore Mutual is making bold moves to reposition our company as a purpose driven, digitally led national insurer. Next Horizon is our 10-year vision and strategy that sets a new path for our company.

Come and make your mark on our Next Horizon!

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