Job Title: Intermediate Claims Examiner Reports to: Lead, Claims

Number of Vacancies: 1 Office Hours: 8:30AM – 4:30PM

May be required to attend off‑hours functions/meetings

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 for ten 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.

KEY RESPONSIBILITIES:

Review initial claim documentation, apply legal/claims analysis and set/amend reserves

Instruct adjuster/lawyer on a continuing basis, settle/deny/defend decisions

Ensure required information/evidence is collected & preserved, authorize mediation & pre‑trial expenses

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

Situational analysis and recommendations for actions on non‑claim matters

Provide advice regarding general risk management queries and/or referral to Healthcare Safety and Risk Management Department





Work with Healthcare Safety and Risk Management Department for education and developing coordinated responses to situations

Work with Insurance Services Department for policy development and revision, education as to new legal developments

Liaise with Finance and Accounting to verify transactions

Continuous skills and knowledge upgrading (negotiation, insurance knowledge, computer abilities, legal developments, court trends, settlement amounts)

Assist with training of current claims examiners and administrative staff

Present to HIROC Subscribers/Healthcare administrators on Insurance and Claims Matters

Other duties as assigned

KNOWLEDGE, SKILLS & ABILITIES:

High regard for quality, attention to detail, and the ability to maintain confidentiality

Well organized and able to meet deadlines, excellent time management skills

Willing to demonstrate initiative

Ability to maintain a high level of accuracy

Knowledge of principles and practices of basic office procedures

Excellent verbal, written and oral communication skills

Advanced working knowledge of the Microsoft Office suite of tools, with particular emphasis on Outlook, Word and Excel

Ability to exercise discretion and tact in sensitive and confidential situations

Well‑developed analytical skills

Ability to work both independently and as a team member

Flexible in approach and enjoys a variety of work

Valid Ontario G driver’s licence and access to a vehicle

EDUCATION, TRAINING & EXPERIENCE:

Experience handling Commercial General Liability (CGL), medical malpractice, property, crime, and cyber claims preferred

Minimum of 2 years of university education or other post‑secondary education

Completion of or enrollment in CIP, FCIP, and/or CRM required courses

Minimum of 5 years’ working experience with claims processing activity or equivalent responsibility

Most importantly, you are an enthusiastic and creative thinker,



who is constantly driving performance improvement and are passionate about creating the safest health care system possible for Canadians.

WORKING CONDITIONS:

Working at a computer for much of the day

Monday-Friday 8:30am–4:30pm. May be required to attend after‑hours functions/meetings

HIROC is committed to a hybrid work environment, which includes 2 days per week in office, with departments meeting in person at least two times per month, as per HIROC’s Hybrid Work Policy. HIROC’s hybrid model provides opportunities for team building, education, leadership development and cross departmental relationship building.

SALARY RANGE:
$87,000.00 - $105,000.00. The salary range offered for this position will be determined by a variety of factors including the candidate’s skills, competencies, qualifications and relevant experience, in accordance with HIROC’s Compensation Policy.

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.

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📌 Intermediate Claims Examiner (Ontario)
🏢 Healthcare Insurance Reciprocal of Canada (HIROC)
📍 Ontario