Job Details
Claim Examiner (5617)

Job Posting

Claim Examiner
Organization:  Sutton Special Risk
Province:  Ontario
Location:  Toronto
Job Start Date:  04-Apr-2024

BRIEF DESCRIPTION: Reporting to the Manager of Claims, this full-time role is responsible for the adjudication of accident & health claims and related customer service.


  • Manage a portfolio of Medical, Disability and Critical Illness claims including oversight of reporting, notification, evaluation, case reserving, settlement and file closure.
  • Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution
  • Settlement of claims within designated authority.
  • Regular communication with the claimant and the client.
  • Manage relationships with, and ensure appropriate handling by, external TPAs, adjusters and counsel.
  • Identify process improvements and recommend changes to policies or procedures to improve quality of service and competitiveness.


  • 5+ years of Accident & Health claims experience. Some commercial P&C experience an asset.
  • A college diploma or a university degree is an asset.
  • Experience working with Lloyd’s coverholders an asset.
  • Have a strong ability to multitask and thrive in a fast-paced environment.
  • Are a skilled communicator.
  • Bilingual (English/French) preferred.
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