Claim Analyst

Claims Analyst is responsible for reviewing, assessing, and adjudicating health insurance claims in accordance with policy provisions, company guidelines, and regulatory requirements. This role ensures claims are processed accurately, fairly, and within established service standards, while maintaining compliance with internal procedures and risk controls.

In addition, the Claims Analyst works closely with customers, healthcare providers, and internal stakeholders to gather and validate claim information, resolve inquiries, and support timely claim resolutions. The role plays a key part in delivering a positive customer experience by balancing efficient claim handling with high standards of quality and service.

Position Responsibilities

• Review and assess health insurance claims submitted by members and healthcare providers.
• Verify the completeness and accuracy of supporting documents, including medical diagnoses, treatment records, investigation results, and medical expenses.
• Validate policy eligibility, benefits, coverage limits, exclusions, and applicable terms before making claim decisions.
• Determine claim outcomes, including approval, rejection, partial approval, or requests for additional information.
• Identify potential fraud, abuse, or irregular claim activities and escalate cases when necessary.
• Liaise with hospitals, clinics, healthcare providers, brokers, and policyholders to obtain additional information and resolve claim issues.
• Ensure claims are processed within the company's established Service Level Agreements (SLAs).
• Communicate claim decisions professionally and clearly to internal and external stakeholders.
• Ensure compliance with company policies, regulatory requirements, and governance standards.

Required Qualifications

• Bachelor's degree in Medicine, Nursing, or a related healthcare field.
• Experience in health insurance claims, managed care, TPA, or health insurance operations is preferred.
• Strong understanding of medical terminology, health insurance benefits, and claims adjudication processes.
• Excellent analytical and investigative skills with strong attention to detail.
• Proficient in Microsoft Office, particularly Excel.
• Self-motivated, collaborative, and proactive in driving outcomes.
• Willing to work under a contract employment arrangement.

Preferred Qualifications

• Strong communication, coordination, and stakeholder management skills

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.

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].

Hybrid