Job opportunity
Team Leader, Quality Services
Guardian Ambulance
Position Type: Permanent
If you're looking for a fulfilling career that can make a real difference in your life, and the lives of others, you've come to the right place.
As a national health solutions partner, we put people first in everything we do - and that begins with our team of 8,000+ professionals who bring a cross-section of diverse life experiences and career expertise to Medavie. By collaborating and innovating together, our employees are creating industry-leading solutions in insurance, primary care and emergency medical services that impact millions of lives in Canada each year.
Our mission is to improve the wellbeing of Canadians so that every life can be lived to the fullest - and it's reflected in our award-winning culture. We celebrate individuality and value the diverse perspectives and skills our employees contribute. We go beyond providing competitive pay and comprehensive benefits to offer opportunities for personal and professional growth, flexible work options, meaningful experiences, and supportive leadership. Medavie is where employees can be their best selves, feel they belong, and achieve their full potential. Be part of it by applying for a position with us today.
Reporting to the Manager, Quality Services, the incumbent leads the Life & Critical Illness (CI) Claims team and the Appeals team, which is responsible for reviewing appeals across all Life and Disability claim lines. The role ensures consistent, fair, and timely adjudication practices, supports complex case decision‑making, and promotes high‑quality service delivery.
The incumbent provides direction, coaching, and technical expertise to adjudicators and Appeals specialists, ensuring decisions align with contractual provisions, industry standards, and Medavie's values. This role also contributes to the development and refinement of claims processes, training materials, and documentation to support operational excellence.
The Team Leader acts as a key liaison between Quality Services, Claims Operations, Medical Services, Legal, and other internal partners. The role supports departmental initiatives, participates in cross‑functional projects, and fosters a culture of continuous improvement and professional development.
What You'll Do:
Leadership of Life & CI Claims and Appeals Teams
Provide day‑to‑day leadership, coaching, and guidance to Life & CI adjudicators and Appeals specialists.
Support adjudicators with complex, sensitive, or precedent‑setting claims.
Ensure Appeals reviews are completed objectively, consistently, and within service standards.
Oversee workload distribution, case prioritization, and team performance.
Adjudication Quality, Case Review & Decision Support
Provide technical expertise on Life, CI, and Disability contract interpretation.
Review complex or escalated cases, offering recommendations or direction as needed.
Ensure decisions are well‑reasoned, clearly documented, and aligned with policy wording and best practices.
Identify trends in decision‑making and provide coaching to strengthen adjudication quality.
Process Improvement, Documentation & Operational Support
Identify opportunities to enhance claims processes, workflows, and decision‑making tools.
Collaborate with Operations, Medical, Legal, and other partners to refine guidelines and procedures.
Support the development and maintenance of training materials, job aids, and reference documents.
Participate in system or process enhancement initiatives impacting Life, CI, or Appeals workflows.
Reporting, Insights & Stakeholder Communication
Prepare and deliver reports on team performance, Appeals outcomes, trends, and emerging issues.
Communicate updates, risks, and recommendations to leadership.
Maintain strong relationships with internal partners to ensure alignment on claims practices and service expectations.
Staff Development & Performance Management
Set individual goals, conduct performance reviews, and develop action plans to support growth.
Provide ongoing coaching, training, and mentorship to build technical expertise and decision‑making confidence.
Foster a collaborative, supportive, and high‑performance team culture.
What You Bring:
Post‑secondary university or college degree
Minimum 5 years previous experience in Life, CI and/or Disability Claims; Strong understanding of adjudication and Appeals processes
10 years of experience in the insurance industry (Life and Disability), including 1 year in a supervisory capacity in Life and Disabilit
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Apply on source site If you're looking for a fulfilling career that can make a real difference in your life, and the lives of others, you've come to the right place.
As a national health solutions partner, we put people first in everything we do - and that begins with our team of 8,000+ professionals who bring a cross-section of diverse life experiences and career expertise to Medavie. By collaborating and innovating together, our employees are creating industry-leading solutions in insurance, primary care and emergency medical services that impact millions of lives in Canada each year.
Our mission is to improve the wellbeing of Canadians so that every life can be lived to the fullest - and it's reflected in our award-winning culture. We celebrate individuality and value the diverse perspectives and skills our employees contribute. We go beyond providing competitive pay and comprehensive benefits to offer opportunities for personal and professional growth, flexible work options, meaningful experiences, and supportive leadership. Medavie is where employees can be their best selves, feel they belong, and achieve their full potential. Be part of it by applying for a position with us today.
Reporting to the Manager, Quality Services, the incumbent leads the Life & Critical Illness (CI) Claims team and the Appeals team, which is responsible for reviewing appeals across all Life and Disability claim lines. The role ensures consistent, fair, and timely adjudication practices, supports complex case decision‑making, and promotes high‑quality service delivery.
The incumbent provides direction, coaching, and technical expertise to adjudicators and Appeals specialists, ensuring decisions align with contractual provisions, industry standards, and Medavie's values. This role also contributes to the development and refinement of claims processes, training materials, and documentation to support operational excellence.
The Team Leader acts as a key liaison between Quality Services, Claims Operations, Medical Services, Legal, and other internal partners. The role supports departmental initiatives, participates in cross‑functional projects, and fosters a culture of continuous improvement and professional development.
What You'll Do:
Leadership of Life & CI Claims and Appeals Teams
Provide day‑to‑day leadership, coaching, and guidance to Life & CI adjudicators and Appeals specialists.
Support adjudicators with complex, sensitive, or precedent‑setting claims.
Ensure Appeals reviews are completed objectively, consistently, and within service standards.
Oversee workload distribution, case prioritization, and team performance.
Adjudication Quality, Case Review & Decision Support
Provide technical expertise on Life, CI, and Disability contract interpretation.
Review complex or escalated cases, offering recommendations or direction as needed.
Ensure decisions are well‑reasoned, clearly documented, and aligned with policy wording and best practices.
Identify trends in decision‑making and provide coaching to strengthen adjudication quality.
Process Improvement, Documentation & Operational Support
Identify opportunities to enhance claims processes, workflows, and decision‑making tools.
Collaborate with Operations, Medical, Legal, and other partners to refine guidelines and procedures.
Support the development and maintenance of training materials, job aids, and reference documents.
Participate in system or process enhancement initiatives impacting Life, CI, or Appeals workflows.
Reporting, Insights & Stakeholder Communication
Prepare and deliver reports on team performance, Appeals outcomes, trends, and emerging issues.
Communicate updates, risks, and recommendations to leadership.
Maintain strong relationships with internal partners to ensure alignment on claims practices and service expectations.
Staff Development & Performance Management
Set individual goals, conduct performance reviews, and develop action plans to support growth.
Provide ongoing coaching, training, and mentorship to build technical expertise and decision‑making confidence.
Foster a collaborative, supportive, and high‑performance team culture.
What You Bring:
Post‑secondary university or college degree
Minimum 5 years previous experience in Life, CI and/or Disability Claims; Strong understanding of adjudication and Appeals processes
10 years of experience in the insurance industry (Life and Disability), including 1 year in a supervisory capacity in Life and Disabilit
#J-18808-Ljbffr