Manulife
Financial Services
SeniorAnalyst,AssessmentClaims
Neural analysis suggests this role is
optimal for Mid candidates.
“Senior Analyst, Assessment Claims at Manulife. Skills: healthcare claims assessment, reimbursement, direct billing. Review and assess reimbursement claim submissions to ensure accuracy and compliance with policy guidelines. Validate supporting documents such as invoices, medical records, and prescriptions”
What You'll Achieve.
ensure accuracy and compliance with policy guidelines; Calculate eligible reimbursement amounts; control medical expenses and prevent misuse
Industry & Context.
analytical proficiency; Ability to make quick and accurate decisions under time pressure
What They're Looking For.
Must Have
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, communication and analytical proficiency in MS Office and claims workflow systems
Nice to Have
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
What You'll Do.
Review and assess reimbursement claim submissions to ensure accuracy and compliance with policy guidelines
Validate supporting documents such as invoices
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
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 misuse
Record decisions in the system and coordinate with back‑office teams for settlement
How You'll Work.
Team & Collaboration
coordinate with back‑office teams for settlement
Communication Scope
communication; English proficiency
Full Job Description
**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 misuse. * 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 op
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