- Expertly adjudicate assigned claims, communicate critical issues and claim handling requirements clearly. and professionally to clients and capture data effectively and efficiently.
- Evaluate and proactively support clients in enhancing claim practices via training or one-on-one discussions.
- Contribute to internal claims department initiatives and selected internal projects.
- Share business-critical knowledge across team and organization.

Position Overview

- Expertly adjudicate assigned claims, communicate critical issues and claim handling requirements clearly. and professionally to clients and capture data effectively and efficiently.
- Evaluate and proactively support clients in enhancing claim practices via training or one-on-one discussions.
- Contribute to internal claims department initiatives and selected internal projects.
- Share business-critical knowledge across team and organization.

Your role:

Claim Adjudication

- Conduct expert individual claim adjudication within internal quality standards, delegated authority limits and client response timelines.
- Identify coverage and payment discrepancies, address and resolve coverage anomalies.
- Proactively identify, assess, manage and resolve claim evidence inconsistencies with clients.
- Promptly approve payments in accordance with payment authorization protocols and client service level agreements.
- Archive all claim documentation in an appropriate and orderly manner, perform required claim file follow ups.
- Utilize data management and claim system software and tools effectively to adjudicate and monitor claim risks.

Client Management

- Establish strongly positive, beneficial,



long-term client relationships through professional, timely and knowledgeable communication.
- Monitor client claim results and provide accurate client information on a timely basis to Management through claim analytics, data mining and trend analysis.
- Assist with identifying/implementing initiatives to enhance claim handling efficiencies and effectiveness.
- Develop and implement strategies to track and improve claim results or client expertise.

Risk Monitoring and Claim Audits

- Validate treaty compliance during client claim audits, communicate findings to internal business partners, and provide best practice recommendations for action/resolution.
- Produce excellent written analytical client audit reports with sound recommendations within expected timeframes.
- Follow up on recommended client actions to improve client review results.
- Present claims to Senior Management for evaluation/authority including completion of pertinent claim summary reports and notice of high exposure claims.

Knowledge Transfer

- Provide technical mentoring on complex claims to clients or internal Claims team members.
- Develop and deliver leading-edge knowledge of insurance claim investigations and practices through presentations, surveys and publications.
- Engage with pricing, underwriting,



and legal to ensure treaty and contractual liabilities, product language and client decisions meet Munich Re’s risk standards and intent.
- Apply expert risk management knowledge/analysis to claim scenarios and share expertise throughout the organization.

Your Profile:

- Minimum 3+ years in insurance claims, with primary expertise in Individual or Group Disability claims, and/or Long Term Care, Critical Illness as well as Life claims. Reinsurance experience is an asset.
- Bilingual in English/French, with demonstrated verbal and written proficiency required.
- Demonstrated ability to build solid client relationships. Experience in customer service/call centre is an considered an asset.
- University degree in combination with LOMA, ICA or other insurance designations.
- Requirement to work in Toronto office under hybrid work model
- Demonstrated thoroughness, accuracy and attention to detail in claim reviews and data capture.
- Strong analytical and inquisitive skills.
- Excellent attention to meeting time service and achieving deliverables.
- High degree of self-motivation, continuing development and proven ability to work independently.
- Demonstrated desire and aptitude to learn multiple lines of business and claim types.
- Excellent presentation and report creation and delivery skills, robust verbal and written communication skills.
- Knowledge of Underwriting concepts and medical terminology is an asset.
- Power BI and related coding skills is an asset.
- Limited travel within Canada is expected.

About Munich Re

Together, we engage with everything we have and are, to help hu

📌 Account Manager, Claims (Toronto)
🏢 Munich RE
📍 Toronto