The Claims Process Lead is responsible for hands‑on daily cla ims assessment while simultaneously leading process review, standardization, and continuous improvement initiatives within the MR claims operation.

This role acts as a bridge between operations, process governance, and system transformation, ensuring stable daily performance while improving efficiency, quality, and compliance in claims handling.

Position Responsibilities:

Key Responsibilities

1. Daily Assessment

Perform daily assessment of healthcare reimbursement (MR) claims, ensuring accuracy, policy compliance, and correct benefit application.
Handle complex, high‑risk, or escalated cases and provide guidance to assessors when required.
Conduct peer review / second‑level review of assessed cases to ensure quality and consistency.
Identify recurring errors, gaps, or interpretation issues during daily assessment activities.
Support SLA and TAT achievement while maintaining quality standards.
2. Process Review & Improvement
Review end‑to‑end claims handling processes including intake, assessment, approval, and closure.
Identify inefficiencies, manual workarounds, rework drivers, and compliance risks.
Propose and implement process improvements, standard operating procedures (SOPs), and work instructions.
Lead or support process changes related to system enhancements, IDP output, MMS workflows, or product updates.
Ensure process alignment with internal policies, regulatory requirements, and audit expectations.
3. Stakeholder & Project Support
Act as a key contact point between Claims Operations, IT, Project teams, and vendors for process‑related topics.
Support UAT, go‑live readiness, and post‑go‑live stabilization from a process and operational perspective.
Participate in governance forums, internal reviews, audits, and transformation initiatives.

Required Qualifications:

Proven experience doing daily claims assessment, including complex or escalated cases.
Solid understanding of MR claims workflows, policies, benefit rules, and medical terminology.
Experience in process review, SOP development, or operational improvement.
Strong analytical and problem‑solving skills.
Proficiency in MS Excel and MS Office ability to interpret operational data.
Hands‑on experience using claims processing systems.

Preferred Qualifications:

Experience of acting as senior assessor, quality reviewer, team lead, or process focal point.
Exposure to system transformation, IDP, workflow changes, or UAT/go‑live projects.
Ability to balance daily operational delivery with improvement initiatives.
Good communication skills with the ability to work cross‑functionally.
English proficiency for reading medical documents, business requirements, and system documentation.

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 .

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 .

Working Arrangement

Hybrid

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