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.

 

Position Responsibilities:

• 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 

Required 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 

Preferred Qualifications:

• 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.

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.

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 RemoteRemote

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.