The Healthcare Insurance Reciprocal of Canada (HIROC) is a trusted healthcare safety advisor, committed to offering a full spectrum of insurance, risk and claims management products and support.

HIROC knows healthcare as it’s the largest not-for-profit healthcare liability insurer in the country, with over 700+ healthcare organizations part of the Reciprocal. Combined with sage counsel and risk management solutions, HIROC works with its partners to increase safety.

As a Reciprocal, HIROC is governed by its Subscribers and remains an innovative, agile and proactive partner. Since its inception in 1987, the not-for-profit has returned over $260 million to the healthcare system. HIROC’s 35 years of data is combined with its extensive experience to advise and share learnings, all with the goal of scaling knowledge and increasing safety across Canada’s healthcare system.

One common thread running through HIROC’s culture is the feeling of being part of something unique: partnering to create the safest healthcare system – HIROC’s vision.

Each employee has the opportunity to find their calling and help build a stronger organization designed to meet the needs of its Subscribers. As a Top 100 GTA Employer nine years running, HIROC employees are empowered to find solutions and create amazing experiences in service to its Subscribers.

Join us and be part of the team working to make a difference.

Job Title: Lead, Claims Examiners

Reports to: Director, Claims           

Status: Full-Time Permanent 

Direct Reports: Yes

Travel Requirements: Some travel required

Office Hours: 8:30AM– 4:30PM - May be required to attend after-hours functions/meetings

Summary

Reporting to the Director, Claims, there are two main priorities of the Lead, Claims Examiners. The first is to provide leadership, guidance, and mentorship to a group of Claims Examiners and to contribute to the overall departmental organization and planning. The second is to collaborate with internal/external partners and subscribers to ensure the effective resolution of claims. This aspect of 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, confirm policy coverage, apply legal/claims analysis and set/amend reserves
  • Document file management strategy, progress, and file-specific details as required (SBAR); escalate concerning file details as appropriate
  • Instruct adjuster/lawyer on a continuing basis, settle/deny/defend decisions
  • Ensure required information/evidence is collected & preserved in claims management systems, authorize expense payments
  • 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-areas of claims as assigned

Subscriber Interaction

  • Policy Interpretation
  • Situational Analysis & Recommendations for actions on non-claim matters
  • Provide advice regarding general risk management queries and/or referral to Healthcare Risk Management Department. Document advice provided to subscribers on a CRM system.

Interaction with Other HIROC Departments   

  • HSRM: Education and Developing Coordinated Responses to Situations
  • Insurance Services: Policy entry and set-up in Oasis, Policy Development and Revision, Education as to new legal developments
  • Finance: Transaction Verification, Assist with CDF function
  • Assist in preparation of claims-specific materials for HIROC reports, both internal and external (ex: Partnership reports, Large Loss Report(s), etc.)

Supervisory duties (Claims Examiners)

  • Oversee a group of Claims Examiners with varying levels of experience
  • Lead claims coverage and reserve change/adequacy discussions
  • Settlement authority as granted by VP
  • Work with Claims Director and VP to implement process improvements
  • Assist in the recruitment, mentorship, and technical instruction of Claims personnel
  • Responsible for the talent management and development of Claims Examiners through HIROC’s development plan processes, mentorship, and training

Additional Specialized Areas

  • Mentorship of new/junior claims staff in collaboration with other Leads
  • Develop strong working relationships and collaborate with Leads across the organization
  • Claims Audit report function/oversight; coordinate with IT / Web portal / BAS
  • Participate in annual department planning process / strategic alignment of initiatives and objectives
  • Lead departmental objectives, where applicable
  • Other duties as required

Knowledge, Skills & Abilities

  • Strong computer skills
  • Excellent communication and interpersonal skills
  • High regard for quality, attention to detail and the ability to maintain confidentiality
  • Well organized and able to meet deadlines
  • Exceptional analytical skills
  • Solution oriented
  • Technical claims knowledge and expertise including but not limited to healthcare professional liability (medical malpractice), Occupiers’ Liability, employment law, property, cyber and E&O/D&O.
  • Valid G driver’s licence and access to a vehicle

Education, Training & Experience

  • Completion of post-secondary education
  • Insurance Institute CIP, FCIP, and/or CRM, or other relevant courses or certificates in a claims-related area
  • 10 years of experience in a claims-related role
  • Most importantly, you are an enthusiastic and creative thinker who is passionate about creating the safest healthcare system possible for Canadians

Working Conditions

  • Working at a computer for much of the day
  • Hybrid working model
  • Some travel required
  • Monday-Friday 8:30am–4:30pm. May be required to attend after-hours functions/meetings

How to Apply

Please submit your résumé to [email protected]

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 fostering a climate of equity, diversity, inclusion, and accessibility. HIROC respects the diversity of all members of its community and welcomes applications from those who have demonstrated a commitment to the values of equity, diversity and inclusion. Applications from members of groups that have been historically disadvantaged and marginalized, including First Nations, Métis and Inuit peoples, racialized persons, persons with disabilities, those who identify as women, 2SLGBTQ+, individuals who self-identify on the basis of any of the protected grounds under the Human Rights Code and/or others who may contribute to the further diversification of ideas within its community are encouraged. HIROC is committed to fair assessment of a candidate’s abilities, and consideration for diversity of thought, method, and experience, including non-traditional career paths.

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