Claims Business Controls Specialist

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.

Claims Business Controls Specialist

The Claims Business Controls Specialist is responsible for leading the implementation and execution of the Quality Assurance Program. This role ensures adherence to the highest standards across all lines of business by conducting file reviews, testing internal practices, creating and maintaining robust processes and procedures. The specialist will provide actionable insights through qualitative and quantitative metrics to support continuous improvement within the Claims department.

Responsibilities:

Leading Claims Audit and Analysis:

• Conduct thorough Quality Assurance audits of claims , ensuring accuracy and compliance with processes.
• Analyze audit outcomes to identify improvement areas and potential risks.
• Collaborate with the Manager Claims Business Controls to implement audit recommendations and refine processes.

Monitoring and testing internal controls & supporting external audits:

• Support the Manager Claims Business Control to monitor and test internal control for adherence on a regular basis
• Supporting the operations to ensure all controls are being met
• Represent Claims during external audit and provide direction/feedback required
• Provide reporting on the operations' performance as it relates to internal control testing
• Continuously report on these metrics, offering insights and analysis

Providing Inputs on Claims Processing and Procedures:

• Analyze current claims processes, suggesting improvements based on data-driven insights.
• Participate in the updating and enhancement of claims handling procedures.
• Collaborate with the Product Management team to create and update procedures and processes related to initiatives impacting Claims

Risk and Compliance:

• Collaborate with the Claims Business Controls Manager to track the Key Risk Indicators on a monthly basis
• Support ERM with the updating of the KRIs on a monthly basis as required
• Engage in all risk and compliance activities as directed by the Claims Business Controls Manager
• Stay up to date on industry best practices and regulatory changes impact the Claims Operations

Stakeholder Communication and Project Support:

• Effectively communicate analytical findings and recommendations to a diverse range of stakeholders.
• Engage in ongoing professional development to remain abreast of industry trends and advancements in data analysis and claims management.
• Facilitate workshops and training sessions for supervisors, emphasizing the importance adhering to audit and oversight requirements

Requirements:

• 5-10 years of Claims lines experience.
• 2-3 years working as a Supervisor
• Undergraduate degree or equivalent experience
• CIP, FCIP or CRM designation or working towards it
• IICRC certification in water remediation and applied structural drying certification including WRT, ASF, AMRT, and FSRT considered an asset
• Experience in audit, risk management, regulatory compliance, processes & controls
• Strong understanding of business operations and internal policies/procedures
• Experience as a claims leader is an asset
• Experience with stakeholder management
• Data Analysis – analysing and interpreting data
• Audit and oversight – ability to develop and maintain tactics to measure adherence to internal controls
• Strategic thinking – capable of aligning performance analysis with the overall business strategy
• Technical Knowledge – understanding of the adjudication requirements of different Claims lines of businesses
• Stakeholder management – ability to work will individuals across different level and lines of businesses
• Multi-line claims experience

#LI-HYB

#INDHP

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.