Adjustment Adjudicator

Manulife

6d•Remote

About The Position

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.

Requirements

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.

Nice To Haves

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.

Responsibilities

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.
Re-adjudication of Health and Dental claims on claims payment system(s) due to policy amendments or system set up changes.
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 loading of claims history for Health and Dental on claims payment systems.
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.
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.
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.
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”.