Healthcare Insurance Reciprocal of Canada (HIROC) is a trusted risk and safety advisor, offering a full spectrum of insurance products and risk management solutions to its partners in the health sector. Founded in 1987 with 52 subscribers, today they insure over 600 healthcare organizations. As a reciprocal, HIROC is governed by its subscribers and its services are continually evolving to meet the needs of a sector where change has become the norm. With their unique business model, HIROC is a differentiator in the health care insurance industry and remains as nimble and proactive today as when it was founded. HIROC’s philosophy is one of focused attention to customer service and unrelenting foresight and innovation that will enable it to meet the needs of its subscribers both today, and tomorrow. This is where you come in.

Summary

Reporting to the Lead, Claims Examiners, the Claims Examiner’s primary responsibility is to collaborate with internal partners and subscribers to ensure the effective resolution of claims. The role will focus on investigating, analyzing and providing accurate and transparent information to all parties involved in the claims process.

Key Responsibilities

Claims Function

  • Review initial documentation, apply legal/claims analysis and set/amend reserves
  • Instruct adjuster/lawyer on a continuing basis, settle/deny/defend decisions 
  • Ensure required information/evidence is collected & preserved, authorize expense payments, mediations & pre-trails
  • Conduct/control negotiations with plaintiff counsel, mediators, pre-trial judges, and claimants
  • Make settlement decisions up to the posted reserve of assigned claims, authorize settlement payments. Handle special-focus-area of specialty claims as assigned.

Subscriber Interaction

  • Policy Interpretation
  • Situational Analysis & Recommendations for actions on non-claim matters
  • R/M Advice

Interaction with Other HIROC Departments

  • R/M: Education and Developing Coordinated Responses to Situations
  • I/O: Policy Development and Revision, Education as to new legal developments
  • F&A: Transaction Verification

Teach/Learn Function

  • Continuous skills and knowledge upgrading (negotiation, insurance knowledge, computer abilities, legal developments, court trends, settlement amounts)
  • Train junior staff
  • Present to HIROC Subscribers/Healthcare administrators on Insurance & Claims Matters

Knowledge, Skills & Abilities

  • Ability to work in a team environment.
  • Ability to problem solve and balance multiple priorities to ensure timelines are met. Strong analytical skills with the ability to apply principles of logic and scientific thinking to a wide range of problems;
  • Excellent verbal and written communication skills with the ability to clearly articulate complex ideas to a wide range of stakeholders.

Education, Training & Experience

  • Completed post-secondary education and 5 years related work experience or an equivalent combination of education and experience.
  • Enrollment in or completion of CIP/FCIP required courses 
  • An enthusiastic and creative thinker, who is constantly driving performance improvement and is passionate about creating the safest health care system possible for Canadians.

How to Apply

Please submit your résumé to HR@hiroc.com.

In order to be considered for this position, please include a current résumé or detailed qualifications summary with your application. Only those selected for an interview will be contacted.


HIROC is committed to providing a barrier-free environment for all stakeholders, including our subscribers, employees, job applicants, suppliers, the public and any visitors who may enter our premises, access our information, or use our services. As an organization, we respect and uphold the requirements set forth under the Accessibility for Ontarians with Disabilities Act (AODA) and its associated standards and regulations and will ensure that we offer a safe and welcoming environment that is respectful of each person's dignity and independence. 

As an organization, HIROC is dedicated to meeting the needs of individuals with disabilities in a timely manner. We understand that providing a barrier-free environment is a shared effort, and as an organization, we are committed to working with the necessary parties to make accessibility a reality for all.