
Senior Manager, Claims Quality Review
- Mississauga, ON
- Permanent
- Temps-plein
- Conduct quarterly portfolio quality reviews on Life & Health claims adjudication and report results to management identifying trends, gaps, and training opportunities as well as raising issues requiring management action
- Lead the development and implementation of risk assessments and audit plans, and collaborate with internal partners on audit findings and recommendations to support business process optimization, compliance, and internal and external audit
- Perform independent quality reviews on claims and actuarial reserve data to identify and report gaps and anomalies for corrective action and management review
- Be a trusted advisor on special projects as the Claims Management Risk subject matter expert (SME), supporting the development from idea stage through to execution
- Collaborate with Claims, Legal, Group Risk, and 2LOD on recommendations with respect to current processes and claim management guidelines and requirements
- University degree, insurance designation (FLMI, CEBS, FALU)
- Minimum 10 years’ experience in Life/Health Claims Adjudication, expert knowledge of L&H products, risk selection principles, insurance regulations, and claims adjudication processes
- Proven skills in conflict resolution as well as strong decision making skills
- Ability to communicate at all levels with clarity and precision both written and verbal; proven ability to earn the trust and collaborate with key stakeholders
- Excellent facilitation and presentation skills
- Advanced skills in MS Word, Excel, and PowerPoint, and experienced with data mining and working with large datasets
- A Total Rewards program that includes flexible benefits, work/life balance and career development programs and investment and retirement savings plans
- Competitive pay and high-earning potential
- All the tools, training, and team support you need to grow your career
- Flexible work/life balance options
- Sophisticated RBCI software tools to boost your productivity