Drug Technical Claims Consultant

The Group Benefits Technical Services, Health and Dental Claims Team, is looking for an analytical, self-starter to join their team as a Drug Technical Claims Consultant on a regular full-time basis. Reporting to the Manager, Health and Dental Claims Operations, the Drug Technical Claim Consultant is accountable for providing technical support to various internal and external customers on claims payment practices and procedures.

 

 

Position Responsibilities:

• Ensure that Drug Claims are handled in accordance with contractual policy provisions by establishing sound business rules/administrative guidelines for claims adjudication

• Provide technical expertise to internal and external customers to facilitate claims payment, resolve escalated complaints, manage new issue support etc.

• Provide technical expertise for the development of new product offerings, claim initiatives and client customizations that relate to the drug benefit

• Attend client meetings as required

• Attend litigation/arbitration sessions in court

• Accurate release of claims payments up to $80,000.00

• Ensure DIN files and drug plans are updated as new drugs, formulary and pricing information is introduced

 

 

Required Qualifications:

• Post-Secondary education in a related field - pharmacy or nursing background would be an asset

• Thorough knowledge of the Claims admin/payment systems including GIPSY, GRID, Clients II, ESC and V3

• Computer proficiency with MS Word, Excel, Powerpoint

 

 

Preferred Qualifications:

• Understanding of Federal and Provincial Health Care legislation would be an asset

• Excellent understanding of claim administrative procedures, contractual provisions and drug product offerings 

• Excellent written/oral communication/customer service skills

• Good presentation and negotiation skills

• Strong analytical, research, problem-solving and decision-making skills

• Effective project management capabilities

• Ability to review and analyze critical data to make formal recommendations for process improvements

• General understanding of medical terminology, diseases and drug formularies

• Comfortable speaking with external parties such as pharmacists, health care providers, drug manufacturers, government agencies, plan members and plan sponsors etc.

• Must be able to decipher health industry information and understand how it relates to Group Benefits' plans

• Proven ability to manage/schedule a fluctuating, unpredictable workload

• General understanding of all Group Benefits departments

 

 

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.

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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 recruitment@manulife.com.

Referenced Salary Location

Waterloo, OntarioHybrid

Salary range is expected to be between

$51,975.00 CAD - $86,625.00 CAD

If you are applying for this role outside of the primary location, please contact recruitment@manulife.com for the salary range for your location. 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. Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance.

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 recruitment@manulife.com for more information about U.S.-specific paid time off provisions.