Claims Adjudicator

BilingualBilingualFull TimeRemoteMid LevelTeam 10,001+Since 1887H1B SponsorCompany SiteLinkedIn

Location

Canada

Posted

3 days ago

Salary

C$39.2K - C$65.4K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Claims Adjudicator

Manulife

Role Description The Claims Adjudicator is responsible for reviewing, assessing, and adjudicating health and dental claims accurately, fairly, and on time, in accordance with plan provisions, legislation, and organizational standards. This role contributes directly to the member experience by ensuring benefit decisions are clear, well documented, and customer focused, while safeguarding financial integrity and organizational reputation. - Review, assess, and adjudicate routine to complex health and dental claims in accordance with policy contracts, regulatory requirements, and internal guidelines. - Ensure claims are complete, accurate, and processed within established turnaround times and service standards. - Make empowered decisions that may impact member benefit entitlement and payment amounts. - Independently manage daily workload while prioritizing urgent or high-impact claims. - Communicate professionally in writing, or via phone call, as needed with healthcare providers, service vendors, internal partners, and members to clarify claim information as required. - Apply risk management practices to identify errors, irregularities, or potential fraudulent activity. - Contribute to quality improvement initiatives and process enhancements. Qualifications - Post-secondary education or an equivalent combination of education and relevant experience. - Experience in claims adjudication, insurance, benefits administration, healthcare, or a related field is an asset. - Strong attention to detail with effective problem-solving and assessment skills. - Clear, professional verbal and written communication skills. - Strong customer service orientation with sound judgment and initiative. - Proficiency with Microsoft Office 365 and comfort learning new digital systems. - Ability to work independently and collaboratively in a fast-paced environment. Requirements - Strong analytical thinking and effective decision-making. - High level of organization and time management. - Detail-oriented with a consistent focus on quality and accuracy. - Customer-focused approach, balancing empathy with policy adherence. - Clear, respectful, and professional communication. - Effective collaboration across teams and business units. - Adaptability and resilience in a changing environment. - Solution-focused problem-solving mindset. - Accountability and ownership of results. - Continuous improvement orientation and openness to learning. - Integrity, professionalism, and respect for confidentiality. - Ability to maintain composure, confidence, and approachability under pressure. - Bilingualism (English and French) is an asset. If the successful candidate is in Québec, proficiency in both languages will be required to support clients from various provinces outside of Quebec. Benefits - 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. Company Description 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 our story .

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