The Adjustment Adjudicator role performs a variety of functions with a primary focus on the accurate and timely handling of adjustments and investigations of issues to achieve customer resolution. Work is received from a variety of sources including written and verbal plan member-initiated requests via the Customer Contact Centre, in addition to internal parties within the business.
Position Responsibilities:
Individual Accountabilities (System Adjustments): 75%
Daily Adjustments:
- Process transactions such as adjustments, stop payments, cheque reissues and exception requests and conduct investigations into claim issues that stem from the problem resolution process through Customer Contact Centre or from direct contact into the Claims Organization.
- Establish and maintain quality customer service within our turnaround times using influence with internal and external clients to meet all pre-established service standards in order to delight our customers
- Assume ownership of assigned claims/adjustments with an understanding of the urgency of specific cases and effectively prioritize work accordingly.
- Accountable for any written communications to the Plan Member required in the due course of the adjustment process
- Accountable for tracking errors to achieve consistency and identify training issues and other trends that impact the Customer. This information gets fed back to the Claims Management team and the Claims Adjudicators to be used in their overall development and performance.
- Accountable for handling and processing Claims Exception requests which are requested from the Underwriter or the Account Executives and may come directly to the unit or through the Customer Contact Centre
- Adjustments required due to policy amendments or system set up changes
Retro Adjustments: Specific Project Requests
- Re-adjudication of Health and Dental claims on claims payment system(s) due to policy amendments or system set up changes
Other: 25%
Suspense Account Reconciliation:
- Review and correct accounting transactions generated due to items not balancing, to be compliant with SOX Audit for Health and Dental on our claims payment system
- Work closely with Accounting Controls on identifying trends/system issues to decrease the amount of non-balance items
Manual History Transfers/Loads:
- Manual loading of claims history for Health and Dental on claims payment systems
Allianz History Loads:
- Accountable for the manual load of history for out-of-country claims processed by Allianz for the Clients II system
- Record any refunds received from Government Plans
Alberta and British Columbia Unclaimed Property Process:
- Accountable for the investigation and reasonable effort to locate and issue cheques to AB and BC residents that are now stale-dated (unclaimed) as legislated by the Government
- Reports are run on all claims systems twice a year to identify any cheques exceeding $200 that have been unclaimed for at least 3 years
- This investigation needs to follow the guidelines as set out in the Legislation
General
- Responsible for providing peer training to new and existing team members on multiple systems and benefits as required
- Provide a high level of customer service and professionalism to our internal and external customers
- Provide support on projects or to other areas when needed
Key Shared Accountabilities:
- Commitment to Financial Efficiency and Continuous Improvement targets, as required
- Commitment to improving NPS (customer) scores based on overall CX goals
- Commitment to the achievement of the divisional and organizational “Must Win Battles”
Required Qualifications:
- Superior understanding of the claims payment and all related system(s)
- Strong working knowledge of Microsoft Office 365 suite of programs
- Excellent knowledge of health and dental claims adjudication practices
- Bilingual (French & English) is required - The successful candidate will be required to communicate in English and French in order to support clients from various jurisdictions outside of Quebec.
Preferred Qualifications:
- Strong customer service focus and the ability to take the initiative
- Good understanding of the various business units in the Canadian Division, and Manulife globally
- Excellent interpersonal skills and the ability to interact and work with others at all levels to achieve customer resolution
- The ability to work effectively as an individual and as part of a team in a fast-paced environment to achieve service expectations
- Highly organized and flexible; possessing a resilient mindset and the ability to manage multiple tasks and deadlines while balancing conflicting priorities.
- Ability to respond constructively and decisively in challenging situations and to respond positively to change.
- Excellent problem-solving and efficient decision-making skills
- An analytical thinker who is detail, solution and action oriented
- Sound knowledge of medical and dental terminology and practices as well as provincial legislation and regulations
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
The role being advertised is an existing vacancy.
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 [email protected].
Referenced Salary Location
CAN, Ontario - Full Time Remote
Remote
Salary range is expected to be between
$39,225.00 CAD - $65,375.00 CAD
Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance. 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. If you are applying for this role outside of the primary location, please contact [email protected] for the salary range for your location.
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 [email protected] for more information about U.S.-specific paid time off provisions.
We use data and analytics technologies, such as artificial intelligence (AI), and automated processing tools, to analyze and process the information you provide to us or third parties in the application process. For more information, please refer to our personal information collection statement.
