CLAIMS EXAMINER

ABOUT THE JOB

Claims Examiner

Ontario School Board Insurance Exchange

Location: Guelph, ON

Position: Full-Time (HYRBID)

Salary: $60,000 - $80,000 per year

ABOUT OSBIE

The Ontario School Boards’ Insurance Exchange (OSBIE) is a non-profit insurance company providing commercial lines of insurance to the school boards of Ontario. We classify ourselves as a boutique insurance company with a highly qualified and close group of employees. At OSBIE we foster a customer-focused culture and have great people working here, helping us ensure we provide excellent service to our subscribers. Our people are our greatest asset and at OSBIE we aim to balance work and play by providing our employees with hybrid work arrangements and a variety of social settings and events that promote a collaborative and connected work environment.

Position Summary:

The Claims Examiner contributes to the success of OSBIE by managing claim files across all lines of business, ensuring timely and accurate claim handling, policy interpretation, and compliance with internal and external requirements. This role involves examining claims, determining liability, interpreting coverage, assessing damages, providing direction to investigators, adjusters, appraisers, and legal counsel, and negotiating settlements. The Claims Examiner ensures that claims are managed fairly, equitably, and in a legitimate and reasonable manner while maintaining effective communication with stakeholders.

Key Responsibilities:

• Interpret policy coverage across all lines of business, obtaining pre-approval from the Director of Claims for any coverage denials.
• Establish and maintain claim files in the claims management system.
• Post reserve developments promptly and ensure the adequacy of indemnity and expense reserves.
• Assess liability and quantum, maintaining up-to-date BI worksheets for liability claims.
• Conduct detailed bill reviews to enforce sound litigation management and expense control.
• Appoint and oversee external service providers, including adjusters, appraisers, legal counsel, and consultants.
• Negotiate settlements, authorize payments within authority limits, and participate in mediations and pre-trial proceedings.
• Maintain clear and proactive communication with school boards regarding claim statuses.
• Arrange, prepare for, and attend both private and court-appointed mediation sessions.
• Evaluate complex claims across all policy types and resolve claims complaints as they arise.
• Provide policy interpretation and coverage clarification.
• Identify risks or hazards requiring loss prevention action and report them to Risk Management.
• Review claims exceeding reinsurance retention and communicate relevant details to reinsurers.
• Maintain strong relationships with member boards to ensure seamless collaboration.
• Contribute to the organization and delivery of meetings, seminars, and training sessions for member boards.
• Assist in preparing reports both internal and external.
• Participate in the development and execution of departmental operational and strategic initiatives.
• Stay current on case law, statutes, and industry best practices, applying them to claims handling.
• Perform additional duties as assigned.

Supervision:

• General supervision from the Director of Claims and Loss Control for claim settlements exceeding individual authority and for management responsibilities.

Key Contacts:

• Regular interaction with member boards, claimants, investigators, adjusters, appraisers, solicitors, repairers, insurers, and witnesses.
• Frequent communication with claims consultants, medical professionals, and industry representatives.

Qualifications & Skills:

• Community college diploma or university degree in insurance or business required.
• Obtained or working towards Chartered Insurance Professional (CIP) designation preferred.
• 3-5 years of claims experience (preferably across multiple lines of business)
• Strong knowledge of insurance policies, legal and medical terminology, depreciation, replacement costs, and industry best practices.
• Excellent negotiation and interpersonal skills.
• Strong analytical and decision-making abilities for complex claims.
• Self-motivated with the ability to work independently.
• Commitment to professional development and continuous learning.
• Exceptional verbal and written communication skills.
• Strong time management and task prioritization abilities.
• Proficiency in computer systems and claims management software.
• Ability to travel occasionally. Fluency in written and verbal French is preferred.

This position offers an opportunity to contribute to effective claims management while ensuring fair and efficient resolutions for all stakeholders.

HOW TO APPLY

To be considered for this position, please include a cover letter and current résumé with your application. Only those selected for an interview will be contacted.

OSBIE is committed to providing a barrier-free application and interview process for all candidates. Should you require accommodations due to a disability or medical condition at any point throughout the hiring process, please notify us and we will do our best to meet your needs.