Specialist, Assessment Claims

Position Responsibilities

1. Reimbursement Responsibilities

• Review and assess reimbursement claim submissions to ensure accuracy and compliance with policy guidelines.

• Validate supporting documents such as invoices, medical records, and prescriptions.

• Calculate eligible reimbursement amounts and identify exclusions or non-covered items.

• Escalate suspicious or high‑risk claims following fraud detection protocols.

• Maintain accurate documentation and ensure adherence to SLA/TAT requirements.

2. Direct Billing Responsibilities

• Handle direct billing requests from hospitals and clinics, verifying eligibility and benefit coverage.

• Review and approve pre‑authorization for medical services based on policy rules and medical necessity.

• Communicate with providers to clarify treatment plans and negotiate cost adjustments when required.

• Monitor inpatient cases to control medical expenses and prevent misu se.

• Record decisions in the system and coordinate with back‑office teams for settlement.

Required Qualifications

• 2-3 years of experience in healthcare claims assessment, reimbursement, or direct billing.

• Basic knowledge of medical services, insurance benefits, and medical terminology.

• College or university degree in Healthcare, Nursing, Insurance, or related fields.

• Strong communication and analytical skills proficiency in MS Office and claims workflow systems.

Preferred Qualifications

• Experience working with provider networks or hospital billing departments.

• Ability to make quick and accurate decisions under time pressure.

• Familiarity with cost containment strategies, compliance requirements, and fraud detection.

• English proficiency for reading and understanding medical documents.

When You Join Our Team

• You will be empowered to learn, grow, and build the career you aspire to.

• You will be supported in a flexible environment that values well-being and inclusion.

• As part of our global organization, you will have opportunities to contribute to shaping a future that matters to you.

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 .