Job Title

OverviewJoin a dynamic team within the Group Benefits Health and Dental Claims Risk Management department, where we deliver a broad range of services including digital claims risk management, fraud investigations, data analytics, and claims experience oversight. This role plays a critical part in identifying and mitigating fraud and abuse in drug claims, contributing to the integrity and sustainability of our benefits programs.ResponsibilitiesPerform risk-based data profiling and analysis to identify trends and outliers in various categories for further review and investigationLead and support audit programs; coordinating, assessing, and making decisions on investigationsTake initiative and independently lead investigations to successful conclusionConduct interviews of plan members, providers of service and others as requiredCreate written audits and other correspondence to plan members, providers of service and othersEngage / interact / consult with various internal contacts such as Customer Service, Legal, Client Relations, Medical Consultants, Regional Group Office, and external stakeholders such as Health Practitioner Regulatory Bodies, Colleges and Associations, and Plan SponsorsLead, support and implement key investigative projectsProvide technical expertise to internal customers to troubleshoot claims payment, resolve escalated complaints, support issue trends etc.Provide oversight of the drug audit program and risk assessment of claim initiatives and client customizations that relate to the drug benefitReview and analyze high dollar drug claims and narcotics usageAttend client meetings as requiredAttend litigation / arbitration sessions in court if requiredRequired QualificationsPost-Secondary education or equivalent experience - pharmacy technician or pharmacy assistant background would be an assetGeneral understanding of medical terminology, diseases, and drug formulariesPreferred QualificationsGood presentation and negotiation skillsStrong analytical, research, problem-solving and decision-making skillsEffective project management capabilitiesAbility to review and analyze critical data to make formal recommendations for process improvementsComfortable speaking with external parties such as pharmacists, health care providers, drug manufacturers, government agencies, plan members and plan sponsors etc.Must be able to decipher health industry information and understand how it relates to Group Benefits' plansProven ability to manage / schedule a fluctuating, unpredictable and stressful workloadKnowledge of Group BenefitsKnowledge of the Canadian healthcare environment, service delivery model and regulationExcellent understanding of third-party claims adjudication as it relates to Pharmacy benefitsKnowledge of fraud and abuse risk, and techniques to manage riskStrong research, problem solving and decision-making skillsAbility to manage contentious interactions with various stakeholdersExcellent oral communication (both phone and face to face) and written communicationIntermediate data analysis skills with expertise using Excel and other data mining softwareDemonstrate investigation skills with attention to detailKnowledge of privacy, civil and criminal legal risks and processesWhen you join our teamWell empower you to learn and grow the career you want.Well recognize and support you in a flexible environment where well-being and inclusion are more than just words.As part of our global team, well support you in shaping the future you want to see.#LI-HYBRIDAbout Manulife and John HancockManulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit .Equal Opportunity EmploymentManulife 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 .Referenced Salary LocationMontreal, QuebecWorking ArrangementHybridSalary range is expected to be between$51,375.00 CAD - $85,625.00 CADIf you are applying for this role outside of the primary location, please contact 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 for more information about U.S.-specific paid time off provisions. #J-18808-Ljbffr