The Claims Verification Analyst is responsible for supporting health and dental claims fraud risk controls by authenticating claim submissions, identifying, and investigating issues for action and resolution, and escalating key control issues to the claims risk management team. 

The Claims Verification Analyst will conduct health and dental claims audits by reviewing receipt evidence and supporting documentation, contacting providers and/or plan members to validate submissions, verifying provider licensing through internet searches and contact with professional associations and colleges, and following through on actions from these reviews for successful outcomes.  The auditor will work with our various internal departments including Technical Services, Customer Service, Investigation Services and H&D Operations for the resolution of claims submission issues.

Responsibilities

Reviews audit evidence submissions by plan members to authenticate information, identifies areas of concern, and action issues for resolution, and obtains/requests additional evidence required on suspect claim submissions.

Validates irregular Internet transaction activity through phone call interviews with providers and/or plan members and secures evidence on discrepancies as part of information gathering on suspect claim submission activity.  Requests supporting documentation from plan members and authenticates information, identifying issues and gaps for further review and resolution.

Identifies fraudulent claims, documents and gathers evidence, and supports ongoing management of investigation activity

Confirms provider licensing credentials and legitimate business establishments through Internet searches and by contact with professional associations and colleges. Actions and resolves issues for successful audit outcomes and escalates key provider control issues to the e-commerce control management team

Analyzes data to identify anomalies, trends and patterns; and supports testing and documentation of new risk controls for continuous review of all Internet submission activity

Supports awareness of e-commerce control and operational workflow issues by providing direction and information to internal Group Benefit departments such as the Call Center and various Health and Dental Operation departments

How will you create impact?

The Claims Verification Analyst reports to the Program Manager, Investigation Services, and helps to protect plan sponsors and members from the negative impacts of claims fraud.  This role is focused on risk detection, which is the foundation for our investigation programs and a vital part of claims risk management. 

What motivates you?

You obsess about customers, listen, engage and act for their benefit.

You think big, with curiosity to discover ways to use your agile approach and enable business outcomes.

You thrive in teams and enjoy getting things done together.

You take ownership and build solutions, focusing on what matters. 

You do what is right, work with integrity and speak up.

You share your humanity, helping us build a diverse and inclusive work environment for everyone

What we are looking for

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.

Excellent written communication skills

Ability to manage contentious interactions with various stakeholders and take control of stressful situations with tact and diplomacy

Excellent oral communication skills and ability to interview service providers, plan members and others for successful audit outcomes  

Resourceful with a proven analytical, problem-solving, and troubleshooting background

Proficient in research and quick decision-making

Knowledge of privacy, civil and criminal legal risks, and processes

Strong organizational skills and the ability to manage multiple conflicting priorities in a fast-paced changing environment as well as adapt to changes is essential   

Ability to take action on ideas, situations, or opportunities before being asked

Ability to be skeptical, probing, creative and aggressive in conducting authentication and investigation activity

What can we offer you?

A competitive salary and benefits package.

A growth trajectory that extends upward and outward, encouraging you to follow your passions and learn new skills.

A focus on growing your career path with us.

Flexible work policies and strong work-life balance.

Professional development and leadership opportunities.

Our commitment to you

Values-first culture: We lead with our Values every day and bring them to life together.

Boundless opportunity: We create opportunities to learn and grow at every stage of your career.

Boundless opportunity: We invite you to help redefine the future of financial services.

Delivering the promise of Diversity, Equity and Inclusion: We foster an inclusive workplace where everyone thrives.

Championing Corporate Citizenship: We build a business that benefits all stakeholders and has a positive social and environmental impact.

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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.

Primary Location

Working Arrangement

Salary range is expected to be between

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.