Bilingual Adjustment Adjudicator SHU

The Bilingual Adjustment Adjudicator is accountable for handling claims following high service standards to meet or surpass client expectations. The selected candidate will required to make several determinations that may affect the member's entitlement to benefits and/or the amount of payable benefits. This team is responsible for reviewing claims for completeness, entering and assessing claims, and producing the final statement and/or payment responsibility after the member's insurance benefits are applied to a claim. The Adjudicator will be required to contact various practitioners or service providers to obtain clarification on claim information as necessary.

Position Responsibilities:

Claims Adjudication (80%)

• Assesses highly complex health/dental claims in keeping with contract provisions, taking initiative and ensuring that empowered decision-making is a key component of the process.

• Assume ownership of the claims assigned with an understanding of the urgency of specific cases and effectively prioritize work accordingly.

• Establish and maintain quality customer service within our turnaround times using influence with internal and external clients to meet all pre-established service standards to delight our customers.

Supporting the Business (20%)

• Sound knowledge and ability to apply appropriate risk management tools and techniques.

• Actively participate in various projects that improve effectiveness and efficiency in claims practices in keeping with our culture of continuous improvement.

• Handle all issues and requirements related to the claim to achieve customer/claim resolution handing off only as appropriate. (claims adjustments, warranty investigation, technical decisions)

Required Qualifications:

• College diploma or equivalent experience

• Strong customer service focus and the ability to take the initiative

• Previous claims adjudication and/or relevant insurance or healthcare industry experience a definite asset

• Strong working knowledge of Microsoft O365 suite of programs

• Detail-oriented with quick assessment skills

• Excellent interpersonal skills and the ability to interact and work with others at all levels to achieve customer resolution

• Superior communication skills (verbal and written) for a variety of internal and external audiences (Both in English and French as applicable)

• The ability to work effectively as an individual and as part of a team in a fast-paced environment

Preferred Qualifications:

• Highly organized and flexible; possessing a resilient approach and the ability to lead multiple tasks and deadlines while balancing conflicting priorities. 

• Ability to respond constructively and significantly in challenging situations and to respond positively to change.

• Excellent problem-solving and efficient decision-making skills

• An analytical problem solver who is detail, solution and committed; an active participant in various projects that improve effectiveness and efficiency in claims practices in keeping with our culture of continuous improvement.

• Sound knowledge of medical/ dental terminology and practices as well as provincial legislation and regulations

• Good understanding of the various business units in the Canadian Division, and Manulife globally

When you join our team:

• We’ll empower you to learn and grow the career you want. 

• We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words. 

• As part of our global team, we’ll support you in shaping the future you want to see.

#LI-REMOTE

About Manulife and John Hancock

Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit https://www.manulife.com/en/about/our-story.html.

Manulife is an Equal Opportunity Employer

At Manulife/John Hancock, we embrace our diversity. We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals. We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.

It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies. To request a reasonable accommodation in the application process, contact recruitment@manulife.com.

Salary range is expected to be between

If you are applying for this role outside of the primary location, please contact recruitment@manulife.com for the salary range for your location. The actual salary will vary depending on local market conditions, geography and relevant job-related factors such as knowledge, skills, qualifications, experience, and education/training. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.

Manulife offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and employee/family assistance plans. We also offer eligible employees various retirement savings plans (including pension and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in Canada includes holidays, vacation, personal, and sick days, and we offer the full range of statutory leaves of absence. If you are applying for this role in the U.S., please contact recruitment@manulife.com for more information about U.S.-specific paid time off provisions.