Next Horizon is here. Fueled by investments in talent and technology, our bold strategy to transform is nearly complete.

At Gore Mutual, we've always set ourselves apart as a modern mutual that does good. Now, we're proudly building on that legacy to transform our company—and our industry—for the better.

Our path forward sharpens our focus on business performance, driven by leading technology, innovation and an agile, high-performing culture. With Gore Mutual and Beneva announcing their intent to merge in 2026, we'll be uniting two well-established, financially strong, and trusted brands to become the strongest mutual insurer in Canada, ensuring Canadians have purpose-driven insurance options for generations to come. Come join us.

Senior Advisor, AB

We're now at the boldest phase of our Next Horizon journey. At Gore Mutual, we've completely transformed our business in under three years. By investing in top talent and leading technology, we've redefined what it means to be a modern mutual that does good. Our path forward brings a sharper focus on our business' performance that's powered by innovation and an agile, high-performing culture – we're built for success. We're well on our way to becoming a purpose-driven, digitally led national insurer. Come join us.

An Accident Benefits (AB) adjuster is responsible for evaluating the validity of claims and guiding claimants through the insurance process. They assess the extent of coverage under the policy, ensuring all necessary documentation is completed and submitted. Acting as the main point of contact, they address any questions or concerns from claimants, providing clear explanations of coverages, deductibles, and the steps involved in the claims process. They process claims promptly and fairly, adhering to legal and regulatory requirements set by the Financial Services Regulatory Authority of Ontario (FSRA). They are expected to act in good faith, avoiding unreasonable denial of benefits and ensuring compliance with all relevant laws and regulations. The AB Senior role is responsible for investigating, evaluating, reserving, negotiating, medically managing and settling MIG and Non-Catastrophic AB claims of moderate complexity and value (IRB, Non-Earner/Priority loss transfers within authority). They also serve as formal and informal mentors to our Med Desk adjusting Team.

What will you do?

• Reviewing, investigating and documenting medical reports and claim-related information and the appropriate setting of AB Claims reserves.
• Negotiation and Settlement of claims of moderate complexity.
• This occasionally includes preparing and presenting files for authority or strategic approval as well as attending hearings or case conferences.
• Direct communications with claimants/guardians (phone or written) for medically managed claim files.
• Communication between internal and external legal counsel, case managers, and outside vendors.
• Coaching and mentoring Med Desk Team.
• Invoicing and administrative tasks.

What will you need to succeed?

• Post Secondary Education: Typically a relevant degree/diploma in insurance or a related field.
• Work Experience:
• 5 years of AB Claims Handling experience strongly preferred
• Exposure to LAT Handling process.
• Capable dispute resolution.
• Some litigation management for AB.
• Experience attending and achieving desirable file resolutions through Settlement Conferences.
• Opportunities for internal promotion based on performance and potential.

Skills:

• Effective Communication.
• Critical Judgement and Decision Making.
• Resilience.
• Attention to Detail.
• Claims Negotiation and Settlement.
• Assessment and interpretation of medical reports and injuries.
• Claims Evaluation and Investigation.
• Dispute and Litigation Management for AB Ontario.
• Advanced understanding of SABS.
• Mentoring.

Location:

We're a hybrid team that thrives on the energy and value of in-office collaboration. This role offers the best of both worlds, with 2 days a week spent in our vibrant office in Cambridge or Toronto, Ontario

Gore Mutual Insurance is committed to providing accommodations for people with disabilities during all phases of the recruiting process, including the application process. If you require accommodation, please let us know.

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Accessibility for applicants

Gore Mutual Insurance Company is committed to providing accommodations for people with disabilities during all phases of the recruiting process, including the application process.

If you require accommodation because of a disability, we will work with you to meet your needs. Contact us and a human resources representative will consult with you to determine an appropriate accommodation.

Should you request an accommodation during the interview process, please notify your Talent Acquisition Consultant.