We are a leading financial services provider committed to making decisions easier and lives better for our customers and colleagues around the world. From our environmental initiatives to our community investments, we lead with values throughout our business. To help us stand out, we help you step up, because when colleagues are healthy, respected and meaningfully challenged, we all thrive. Discover how you can grow your career, make impact and drive real change with our Winning Team today.

Working Arrangement

Hybrid

Job Description

The opportunity

The Health Claims Lead will play a critical role in building and developing the Health Claims team, setting up the Health Claims processes and overseeing the overall team performance. This role will be responsible for collaborating with key stakeholders from Underwriting, Actuarial, Reinsurance, Products and others to ensure that processes and services are efficient, effective and compliant with industry regulations. This role will also be responsible for establishing sound claims practices that will positively impact the health portfolio’s bottom line while delivering exceptional customer service.

Responsibilities

• Develop, implement, and maintain the health claims operations and quality standards that are compliant with industry regulations and policy provisions.
• Build and manage a team of claims analysts and provide guidance on processes and best practices to ensure timely and efficient processing of claims.
• Collaborate with cross functional teams, partners and stakeholders to identify opportunities to optimize the claims and overall service process.
• Analyze claims data and identify trends or issues that may impact claims processing or payments and use these to proactively optimize the claims policies and processes and to prevent fraud and improve customer experience.
• Lead the development and management of medical claims cost analytics to help ensure rational health costs by identifying areas of cost savings or opportunities to reduce medical costs while ensuring the delivery of quality health care.
• Partner with the Medical Consultant / Medical Director to review and adjudicate complex claims and make prudent recommendations and/or decisions, where necessary, on medical related cases.
• Develop and continuously optimize the claims straight-through and exception process to ensure that all claims that require further review or escalation are processed promptly and effectively and automated decision systems are accurate and applicable.
• Monitor team performance to urgently address issues encountered and ensure that committed service levels are met.
• Regularly conduct performance reviews and identify strengths, areas for improvement and development plans.
• Set the direction for the team and identify projects and initiatives that are aligned with the organization’s overall targets.
• Develop and implement training programs and mentor the team to ensure claims analysts are up to date on policies, procedures, and regulations.
• Maintain knowledge of regulatory and PhilHealth/UHC changes related to claims processing and adjust processes as needed.

How will you create impact?

The role will be reporting to the Head of Health

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

• Bachelor Degree holder preferably a graduate of a medical or allied Medical course.
• Minimum of 5 years of health adjudication experience in an HMO or insurance company, at least 2 years of Management experience in health claims operations.
• Industry certifications (FLMI, etc.)
• Knowledge in MS Office applications
• Quick thinker and can work independently under pressure
• Able to communicate clearly and effectively with peers, higher management, external partners and stakeholders
• Can effectively lead and manage a team
• Can develop goals and strategies aligned with the organization’s direction
• Knowledge resource for team members
• Can decide on complex claims based on information gathered, product provisions and applicable insurance laws
• Able to clearly explain the rationale behind claim decisions

What can we offer you?

• A competitive salary and benefits packages.
• 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.
• Continuous innovation 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.

About Manulife And John Hancock

Manulife Financial Corporation is a leading international financial services group that helps people make their decisions easier and lives better. With our global headquarters in Toronto, Canada, we operate as Manulife across our offices in Asia, Canada, and Europe, and primarily as John Hancock in the United States. We provide financial advice, insurance, and wealth and asset management solutions for individuals, groups and institutions. At the end of 2022, we had more than 40,000 employees, over 116,000 agents, and thousands of distribution partners, serving over 34 million customers. At the end of 2022, we had $1.3 trillion (US$1.0 trillion) in assets under management and administration, including total invested assets of $0.4 trillion (US $0.3 trillion), and segregated funds net assets of $0.3 trillion (US$0.3 trillion). We trade as ‘MFC’ on the Toronto, New York, and the Philippine stock exchanges, and under ‘945’ in Hong Kong.

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].