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.
- Review initial documentation, 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, 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
- 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
Interaction with Other HIROC Departments
- R/M: Education and Developing Coordinated Responses to Situations
- I/O: Policy entry and set-up in Oasis, Policy Development and Revision, Education as to new legal developments
- F&A: 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 (Intermediate and Senior Claims Examiners)
- Oversee intermediate and senior Claims Examiners
- Lead claims coverage and reserve change/adequacy discussions
- 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 of intermediate and senior Claims Examiners including performance appraisals, training, and discipline
Additional Specialized Areas
- Mentoring of new/junior staff
- Claims Audit report function; coordinate with IT / Web portal / BAS
- Participate in annual department planning process / strategic alignment of initiatives and objectives
- Lead departmental objectives, where applicable
Knowledge, Skills & Abilities
- Strong computer skills in a Windows environment
- Excellent written and verbal communication
- Exceptional interpersonal skills
- Completed post-secondary education
- CIP, FCIP, CRM, ARe, or other relevant courses or certificates in a claims-related area
- 10 years of experience in a claims-related role
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.