Business Controls Specialist

The role of the Business Controls Specialist exists to lead the implementation and execution of the quality assurance program, including completing file reviews for all lines of business,  conducting testing on internal practices, creating and maintaining all processes and procedures and supporting the Manager Claims Business Controls to ensure Claims is adhering to the highest standards and identifying areas of improvement . This role will obtain both qualitative and quantitative metrics that can be provided to the Manager Claims Business Controls to identify areas of improvement.

What you will do:

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 controls for adherence on a regular basis. 

• Supporting the operations to ensure all controls are being met. 

• Represent Claims during internal / 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 Claims Business Controls team to create and update procedures and processes related to initiatives impacting Claims. 

Risk & Compliance 

• Collaborate with the Claims Business Controls Manager to track the Key Risk Indicators monthly. 

• Support ERM with the updating of the KRIs monthly as required. 

• Engagement in all risk and compliance activities as directed by the Claims Business Controls Manager. 

• Stay up to date on industry’s best practices and regulatory changes that 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 

What you need to succeed:

• Post secondary education, Undergraduate Degree.
• CIP/FCIP/CRM designation
• IICRC certifications in water remediation and applied structural drying certification including WRT, ASF, AMRT, and FSRT considered an asset.
• ICAR, CHIEF or other Automotive certifications considered and asset.
• 3-5 years work relevant work experience
• 5+ years of multi Claims line experience considered and asset.
• 2-3 years working as a claims Team Leader considered and asset.
• Experience in audit, risk management, regulatory compliance, processes & controls considered and asset.
• Strong understanding of business operations and internal policies/procedures.
• 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 considered and asset. 
• Stakeholder management – ability to work will individuals across different level and lines of businesses

The expected base salary range for this position is $81,000 - $131,000. Depending on your relevant experience, skills, qualifications, market conditions and business needs, base compensation may vary. You have the potential to earn more through Gore Mutual’s discretionary bonus program which gives you an opportunity to increase your total compensation, provided the business meets its performance targets and you meet your individual goals.

Please note: This range reflects the expected base salary for this role but may not represent the full compensation range for all experience and skill levels. During the recruitment process, we will discuss and consider how your unique qualifications align with the broader range for this position.

Gore Mutual is proud to offer a comprehensive total rewards package which includes extended health and dental benefits, disability insurance, retirement plan matching, paid time off, recognition and perk programs.

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