Claims Legal Consultant, Individual Insurance

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The Senior Claims Consultant plays a pivotal role in managing complex and litigated claims within the Individual Life and Critical Illness insurance domain. This position requires a high level of expertise in insurance products, legal strategy, and stakeholder engagement. The consultant will assess, negotiate, and resolve disputed claims, provide strategic legal consultation, and represent the organization in litigation proceedings, ensuring fair and cost-effective outcomes.

Key Responsibilities:

• Assess, negotiate, and resolve disputed claims, including third-level appeals.
• Prepare and escalate complex cases to the Claims Committee with detailed case summaries.
• Provide consultation to Legal on litigation and pre-litigation strategies.
• Represent the company during lawsuits, including acting as a witness, participating in mediations, settlement conferences, and examinations for discovery.
• Deliver clear, strategic, and proactive legal advice on complex matters.
• Monitor and respond to regulatory inquiries and client concerns.
• Contribute to advocacy initiatives related to legal and regulatory developments.
• Identify and assess key regulatory and reputational risks.
• Conduct independent analysis to resolve strategic issues and inform decision-making.
• Prepare reports on claims trends, emerging issues, and performance metrics.
• Design and produce dashboards and ad-hoc reports to support business insights.
• Build and maintain effective relationships with internal and external stakeholders.
• Ensure alignment across teams and departments.
• Lead communication initiatives to influence behavior and deliver tailored messaging.
• Manage assigned caseload efficiently, escalating issues as needed.
• Participate in quality reviews and implement remediation strategies.
• Follow established policies, procedures, and signing authorities to mitigate operational risks.
• Deliver training and develop tools to support claims operations and compliance.

Qualifications:

• 5-10+ years of relevant experience in life and critical illness claims, with a focus on litigation.
• Strong working knowledge of Microsoft 365 products including Copilot.
• Post-secondary degree in a related field or equivalent combination of education and experience.
• Expert knowledge of insurance products, contracts, and benefit plans (individual, disability, and group).
• Strong verbal and written communication skills.
• Advanced analytical, problem-solving, and influence skills.
• Proven ability to work independently and handle non-routine situations.
• In-depth collaboration and data-driven decision-making capabilities.

The above represents BMO Financial Group’s pay range and type.

Salaries will vary based on factors such as location, skills, experience, education, and qualifications for the role, and may include a commission structure. Salaries for part-time roles will be pro-rated based on number of hours regularly worked. For commission roles, the salary listed above represents BMO Financial Group’s expected target for the first year in this position.

BMO Financial Group’s total compensation package will vary based on the pay type of the position and may include performance-based incentives, discretionary bonuses, as well as other perks and rewards. BMO also offers health insurance, tuition reimbursement, accident and life insurance, and retirement savings plans. To view more details of our benefits, please visit: https://jobs.bmo.com/global/en/Total-Rewards

About Us

At BMO we are driven by a shared Purpose: Boldly Grow the Good in business and life. It calls on us to create lasting, positive change for our customers, our communities and our people. By working together, innovating and pushing boundaries, we transform lives and businesses, and power economic growth around the world.

As a member of the BMO team you are valued, respected and heard, and you have more ways to grow and make an impact. We strive to help you make an impact from day one – for yourself and our customers. We’ll support you with the tools and resources you need to reach new milestones, as you help our customers reach theirs. From in-depth training and coaching, to manager support and network-building opportunities, we’ll help you gain valuable experience, and broaden your skillset.

To find out more visit us at https://jobs.bmo.com/ca/en.

BMO is committed to an inclusive, equitable and accessible workplace. By learning from each other’s differences, we gain strength through our people and our perspectives. Accommodations are available on request for candidates taking part in all aspects of the selection process. To request accommodation, please contact your recruiter.

Note to Recruiters: BMO does not accept unsolicited resumes from any source other than directly from a candidate. Any unsolicited resumes sent to BMO, directly or indirectly, will be considered BMO property. BMO will not pay a fee for any placement resulting from the receipt of an unsolicited resume. A recruiting agency must first have a valid, written and fully executed agency agreement contract for service to submit resumes.