Join Us as a Claims Operations Specialist

Who We Are

Tokio Marine Canada (TMCan) is a Canadian early-stage entrepreneurial commercial P&C; insurer based in Toronto. We partner with select brokers to deliver tailored business insurance solutions across Canada. As part of the Tokio Marine Group, we are able to collaborate under a shared framework while maintaining autonomy and local decision-making.

We support Canadian businesses in taking smart risks by delivering practical insurance solutions and exceptional service through trusted broker partnerships.

The Opportunity

The Claims Operations Specialist supports the development, implementation, enhancement, and ongoing effectiveness of claims systems and related operational processes. The role leads assigned discovery, requirements gathering, business analysis, bordereau mapping, testing, implementation, and enhancement activities in collaboration with Claims Operations, Claims Handlers, internal technology partners, vendors, and other stakeholders.

The position also supports the Director, Claims Operations in administering third-party administrator (TPA) audits and selected governance activities, including audit planning, pre-work, fieldwork, documentation, remediation tracking, and the coordination of annual standard operating procedure (SOP) and workflow reviews.

What You Will Be Doing

Claims Systems, Technology & Projects

Systems & Enhancement

- Lead assigned claim discovery, requirements gathering, business analysis, and workflow-assessment activities, and support IT in solution design and development.
- Translate operational and claims-handling needs into documented business requirements, system requirements, process flows,



mapping specifications, validation rules, test scenarios, and implementation materials, and support IT in defining the related system requirements.
- Work collaboratively with the Manager, Claims Operations, Claims Handlers, IT/ System, vendors, and other stakeholders to ensure system solutions support operational, technical, reporting, and control requirements.
- Support new-program implementation by assessing system and workflow requirements, coordinating bordereau mapping, contributing to configuration decisions, and preparing testing and implementation documentation.
- Support the deployment of new systems and enhancements and coordinate testing activities.

Bordereau Mapping & Data Support

- Lead the analysis and mapping of bordereaux for current and existing programs.
- Document source data, field definitions, transformation requirements, validation rules, exceptions, and expected system outputs.
- Collaborate with Manager, Claims Operations to confirm that mapping and system outputs reflect actual processing requirements.
- Coordinate mapping testing, investigate discrepancies, and support remediation.

TPA Audits & Governance Support

TPA Audit Support

- Support the Director, Claims Operations in administering the TPA audit program.
- Assist with audit planning, scope development, information requests,



audit schedules, evidence tracking, sample preparation, and audit templates.
- Conduct assigned pre-work, file reviews, fieldwork, control testing, evidence assessment, and documentation.
- Maintain remediation trackers and follow up on agreed corrective actions, supporting evidence, due dates, and closure status.

Governance Administration

- Assist the Director, Claims Operations in managing selected governance activities, including TPA audit remediation tracking, annual SOP and workflow review coordination, control evidence collection, and reporting.
- Monitor assigned review dates, action items, evidence requirements, and remediation commitments, and elevate delays or gaps.

SOPs, Workflows & Process Documentation

- Develop and maintain SOPs, workflows, process maps, and supporting documentation for the Manager’s assigned system, TPA audit, and governance responsibilities.
- Support the development or revision of broader Claims Operations SOPs and workflows when assigned by the Director, Claims Operations.
- Assist with coordinating the annual review of Claims SOPs and workflows, while functional leaders remain responsible for documentation supporting their respective day‑to‑day responsibilities.

Operational & Claims-Handling Knowledge

Claims Operations Knowledge

- Maintain sufficient working knowledge of claims intake, assignment, bordereau review and processing, reconciliations, delegated and fronting program structures, policy mapping, loss-fund processes, and related operational workflows.
- Collaborate with the Manager, Claims Operations to understand opera

📌 Claims Operations Governance (Toronto)
🏢 Tokio Marine Canada
📍 Toronto