Experience

KnowRoaming
• Support


TD Insurance

• Canada
• Insurance
• 700 & Above Employee

• Analyst

  • Feb 2017 - Feb 2018

  • Provide exceptional customer service and maintain professional client relationships. • Inform claimants of their entitlements and obligations under the SABS/SPF1. • Conduct detailed investigation and evaluation of first party injury claims by telephone and correspondence, ensuring prompt and equitable settlement of all meritorious claims. • Interpret insurance policy wordings, determine policy coverage’s and ensure effective financial management by setting required case reserves and re-reviewing throughout claim life cycle. • Calculate and pay benefits due, approve and make timely claim payments/adjustments and settlement of claims within designated authority level. • Use appropriate cost containment techniques including strategic vendor partnership to reduce overall claim cost. • Manage and interact with stakeholders throughout the claims process to ensure client’s rehabilitation needs are met. • Verify the nature and extent of injury by preparing file summaries, conducting interviews with employers/health practitioners, and reviewing appropriate medical documentation as required, to obtain all relevant information to the claim. • Direct and manage interactions with vendors, investigators, IME’s, health care professionals and legal representation as applicable toward claims resolution. • Effective claims management by adhering to established quality management protocols, implementation of action plans and Best Practices within each claim; document the rationale for any departure from applicable protocols and metrics. • Keep appraised of changes and trends in the accident benefits/insurance industry through legislation, arbitration decisions, case law and attending all available workshops. Show less

• Technical Support Specialist

  • Jan 2016 - Feb 2017