Bilingual Claims Adjudicators

3 days ago


Montréal, Canada Manulife Full time

**_Are you looking for a supportive, collaborative workplace with great teams and inspiring leaders? You’ve come to the right place. We’re looking for ambitious people who share our values and want to make every day better for people around the world. If this sounds like you, and the career below sounds exciting, we’d like to hear from you. _**

**Working Arrangement**

Hybrid

We are looking for Bilingual Claims Adjudicators to join our team As an Adjudicator, you are accountable for handling claims in accordance with high service standards.

The Adjudicator is required to make a number of determinations that may affect the member's entitlement to benefits and/or the amount of benefits that are payable. The Adjudicator reviews claims for completeness, enters and assesses claims, and produces 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.

**Key Accountabilities**:
1. Claims Adjudication
- 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 in order to delight our customers..

2. Supporting the Business
- Actively participate in various projects that improve effectiveness and efficiency in claims practices in keeping with our culture of continuous improvement.
- Manage all issues and requirements related to the claim to achieve customer/claim resolution handing off only as appropriate.(claims adjustments, warranty investigation, technical decisions)

**Key Shared Accountabilities**:

- Commitment to Financial Efficiency and Continuous Improvement targets, as required
- Commitment to improving cNPS (customer) scores based on overall CX goals
- Commitment to the achievement of the divisional and organizational “Must Win Battles”

**Job Requirements**:

- Bilingual in French and English is required
- College diploma or equivalent experience
- Strong customer service focus and the ability to take the initiative
- Previous claims adjudication and/or relevant insurance or health care 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
- Outstanding 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

M-CA-IN-CM

**About John Hancock and Manulife**

**Manulife is an Equal Opportunity Employer



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