Manager Claims Business Controls

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. Effective January 1, 2026, Gore has joined Beneva—the country’s largest mutual insurance company—as part of its Property & Casualty operations in Ontario and Western Canada. During 2026, Gore will combine its operations with Unica Insurance, Beneva’s Ontario-based subsidiary specializing in niche commercial and personal insurance, creating a stronger, more diversified mutual insurer with greater scale and long-term stability. Every decision and investment remains anchored in long-term benefits to customers, members, and communities. Come join us. As the Manager, Claims Business Controls , you will own the end‑to‑end Claims Business Control Environment, driving a proactive, data‑driven first‑line control strategy that enhances customer outcomes, elevates quality, and optimizes loss cost performance. In this role, you’ll lead quality assurance across all lines of business, strengthen processes and procedures, and oversee control testing, audits, and risk programs to ensure strong governance and continuous improvement within Claims. What you will do: Own the QA operating system for Claims (TFR automation + manual QAR deep dives), including methodology, sampling, calibration, and thresholds; ensure weekly/Monthly cadence and transparent reporting to leaders. Standardize QAR categories (e.g., Communication & Documentation, Coverage/Investigation, Cost Control) and ensure alignment with automated TFR attributes. Run cross‑LOB calibration (AB/APD/Casualty/Property) to improve consistency, and embed phone call audit where required. Turn QA into action: deliver unit and adjuster‑level insights to Operations for coaching, and track actions to closure without using QAR as performance management. Build and lead the Claims audit program for MGAs/DUAs and subscription programs. Maintain the Claims Procedures Manuals (end‑to‑end file handling standards, authorities, audits, vendor protocols) and ensure updates are synchronized across LOB manuals and the Corporate Procedures Manual. Embed ‘file must speak for itself’ standards for documentation, privacy, and compliance; spot‑check adherence through routine internal reviews. Design and execute first‑line control testing (beyond TFR/QAR) focused on leakage controls, authority use, reserve discipline, SLA adherence, and data integrity. Partner with leaders on action plans and evidence packs; track remediation to timely closure and prevent repeat findings. Act as Claims SME and single point of contact for external audits and reviews (e.g., reinsurer audits, KPMG/EY financial audits, SOC2/IT‑control touchpoints that affect Claims workflows). Coordinate request lists, samples, walkthroughs, and management responses. Serve as Claims lead for KRIs: define thresholds aligned to Risk Appetite, publish monthly dashboards, and escalate breaches with root‑cause and mitigation. Represent Claims at ERM/Risk Champions forums; maintain evidence in corporate risk tools and ensure linkage to issue/mitigation programs. Coordinate regulatory readiness and control attestations that touch Claims processes (privacy, fair treatment, complaint handling, etc.). Lead a small team (e.g., QA Analysts / Business Controls Analysts), set goals, develop capability, and manage workload planning. Champion a culture of insightful, forward looking, sustained health reporting in line with the Claims strategy. What you will need: A minimum of 7 years in a leadership or managerial capacity within the insurance sector is essential. This experience ensures familiarity with the nuances and intricacies of leading teams, managing operational workflows, and handling the challenges unique to the insurance domain. The role demands a sound understanding of data analytics related to claims. An ideal candidate should have hands-on experience in extracting, analyzing, and interpreting claims data to make informed decisions. Furthermore, a track record of using performance metrics to monitor, measure, and improve claims processes is crucial. Familiar with all Claim’s lines of businesses with hands on experience with Quality Assurance within Claims. Familiarity with internal and external audit requirements to ensure the organization is meeting the required standards. It's imperative for the candidate to have a history of successfully overseeing and resolving a diverse range of claims. This entails ensuring fair claim assessments, timely resolutions, and maintaining high client satisfaction rates. This experience is indicative of their ability to navigate complex claim scenarios, manage client expectations, and uphold the company's reputation. Given the regional focus, an in-depth understanding of Canada's insurance regulations, market trends, and customer behaviours is crucial. This knowledge aids in ensuring compliance, recognizing market shifts, and adapting strategies to cater to regional needs and demands. Permanent, Full-Time Hybrid: This is a hybrid role. Please note, regular in-person workdays at our Cambridge Office or Toronto Office are expected minimum of two a week. The expected base salary range for this position is $97,000 - $147,000. 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. This posting pertains to an existing vacancy that is actively being filled. 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.