Claim Adjudicator – Long Term Care

Are you looking for a supportive, collaborative workplace with great teams and inspiring leaders? You’ve come to the right place. We’re looking for ambitious people who share our values and want to make every day better for people around the world. If this sounds like you, and the career below sounds exciting, we’d like to hear from you.
Working Arrangement
At Home

The Opportunity
We’re looking for a Claim Adjudicator to join our Long-Term Care Team!
As a Claim Adjudicator you will be a licensed RN responsible for using your expertise to assess clinical information on low to moderate exposure claims consistent with current business protocols. You will also be accountable for ensuring the accuracy of the clinical evidence to compare against policy or plan language in order to determine benefit eligibility on Long-Term Care (LTC) claims. This role exists to ensure that only those policyholders meeting their policy’s criteria for eligibility are approved. While most of the work will be claim adjudication, you may be required to conduct virtual telehealth assessments when needed.

• This position will be work from home

Individual Responsibilities

• Assess clinical needs to determine initial and ongoing eligibility for long term care benefits
• Appropriately set follow-up dates for ongoing benefit eligibility as prescribed by current protocols
• Conduct virtual telehealth assessments as needed
• Appropriately set clinical follow updates based on current protocols
• Make benefit eligibility determinations based on onsite assessments submitted by clinical vendors and/or other clinical evidence on both initial and ongoing claims
• Ongoing monitoring of claims for high-risk activity

Shared Responsibilities

• Collaborate with senior care management staff on specific claim questions to ensure accurate decision-making
• Complete trainings as assigned to maintain currency with protocol and guideline updates
• Collaborate with other business units as needed to provide optimum service to customers
• Participate in regular one-on-one meetings with management, attend staff meetings and attend other work activities as directed by manager

What Motivates You

• You share your humanity, helping us build a diverse and inclusive work environment for everyone
• 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 do what is right, work with integrity and speak up
• You obsess about customers, listen, engage, and act for their benefit
• You take ownership and build solutions, focusing on what matters

What We’re Looking For

• Work within the Long-Term Care industry desirable
• Excellent communication skills
• Strong decision-making skills
• 5+ years of nursing experience working in geriatrics, long term care and/or chronic illness fields
• Fluency with MS Office and ability to learn new computer applications easily
• Ability to work within multi-disciplinary teams as well as work autonomously
• Experience doing telehealth assessments a plus
• Geriatric nursing experience preferred
• Bachelor’s Degree in nursing
• Current R.N. compact license in NLC state is an asset, but not mandatory

What We Can Offer You

• 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
• Professional development and leadership opportunities
• Flexible work policies and strong work-life balance
• A competitive salary and benefits packages

Our Commitment to You

• Boundless opportunity We create opportunities to learn and grow at every stage of your career
• Values-first culture We lead with our Values every day and bring them to life together
• Continuous innovation We invite you to help redefine the future of financial services

Every career at Manulife/John Hancock provides the opportunity to learn new skills and move your career forward. Ready to make an impact somewhere? What are you waiting for? Apply today.
About John Hancock And Manulife
John Hancock is a unit of Manulife Financial Corporation, a leading international financial services group that helps people make their decisions easier and lives better. We operate primarily as John Hancock in the United States, and Manulife globally, including Canada, Asia and Europe. We provide financial advice, insurance and wealth and asset management solutions for individuals, groups and institutions. Assets under management and administration by Manulife and its subsidiaries were CAD$1.3 trillion (US$1.1 trillion) as of June 30, 2021. Manulife Financial Corporation trades as MFC on the TSX, NYSE, and PSE, and under 945 on the SEHK. Manulife can be found at manulife.com.
One of the largest life insurers in the United States, John Hancock supports more than 10 million Americans with a broad range of financial products, including life insurance, annuities, investments, 401(k) plans, and education savings plans. Additional information about John Hancock may be found at johnhancock.com.
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].
Salary & Benefits
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. Please contact [email protected] for additional information.
Manulife/John Hancock 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/401(k) savings plans and a global share ownership plan with employer matching contributions) and financial education and counseling resources. Our generous paid time off program in the U.S. includes up to 11 paid holidays, 3 personal days, 150 hours of vacation, and 40 hours of sick time (or more where required by law) each year, and we offer the full range of statutory leaves of absence.
Know Your Rights I Family & Medical Leave I Employee Polygraph Protection I Right to Work I E-Verify I Pay Transparency
Company: John Hancock Life Insurance Company (U.S.A.)