The Adjustment Adjudicator role performs a variety of functions with a primary focus on the accurate and timely handling of adjustments and investigations of issues to achieve customer resolution. Work is received from a variety of sources including written and verbal plan member-initiated requests via the Customer Contact Centre, in addition to internal parties within the business.
Position Responsibilities Individual Accountabilities (System Adjustments): 75% Daily Adjustments Process transactions such as adjustments, stop payments, cheque reissues and exception requests and conduct investigations into claim issues that stem from the problem resolution process through Customer Contact Centre or from direct contact into the Claims Organization.
Establish and maintain quality customer service within our turnaround times using influence with internal and external clients to meet all pre-established service standards in order to delight our customers
Assume ownership of assigned claims/adjustments with an understanding of the urgency of specific cases and effectively prioritize work accordingly.
Accountable for any written communications to the Plan Member required in the due course of the adjustment process




Accountable for tracking errors to achieve consistency and identify training issues and other trends that impact the Customer. This information gets fed back to the Claims Management team and the Claims Adjudicators to be used in their overall development and performance.
Accountable for handling and processing Claims Exception requests which are requested from the Underwriter or the Account Executives and may come directly to the unit or through the Customer Contact Centre
Adjustments required due to policy amendments or system set up changes
Retro Adjustments: Specific Project Requests Re-adjudication of Health and Dental claims on claims payment system(s) due to policy amendments or system set up changes
Other: 25% Suspense Account Reconciliation Review and correct accounting transactions generated due to items not balancing, to be compliant with SOX Audit for Health and Dental on our claims payment system
Work closely with Accounting Controls on identifying trends/system issues to decrease the amount of non-balance items

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📌 Adjustment Adjudicator (Manitoba)
🏢 Manulife Financial
📍 Manitoba