The Drug Prior Authorization Case Manager is accountable for the full service, end to end management of our most complex Prior Authorization claims including directly communicating with members and providers.

The Case Manager must possess the knowledge and expertise required to manage cases with total autonomy, while meeting service expectations to ensure excellent customer experience.

This role is responsible for managing all claims situations that have unique handling requirements including those that fall outside the scope of system automation and global resourcing.

Also includes the undertaking of challenging scenarios involving extensive research, sensitive/escalated issues and high dollar value claims.

The Case Manager provides direct support to a variety of stakeholders in the organization and is considered a subject matter expert who handles inquiries from various internal and external sources as well as providing peer training.
**Position Responsibilities:**
**Claims Adjudication & Prior Authorization Management (60%)**
Manage the intake, review, and adjudication of Prior Authorization drug requests, assessing submissions against clinical guidelines, plan provisions, and documented approval criteria.

Assume ownership of cases from intake through resolution, prioritizing work based on urgency and complexity.

Communicate claim outcomes to members, providers, pharmacies, and internal stakeholders while meeting service and turnaround time standards.

Conduct research and analysis to resolve complex, escalated, or non-standard claim and authorization scenarios.
**Supporting the Business (40%)**
Serve as a subject matter expert for Prior Authorization and claims adjudication, providing guidance and support to internal teams and outsource partners.

Apply risk management principles and sound judgment when assessing claim requests.

Participate in projects and initiatives that improve operational effectiveness, quality, and customer experience.

Manage escalated claims issues to achieve timely and effective resolution.

Support quality assurance, knowledge sharing, training, and continuous improvement initiatives.
**Key Shared Accountabilities:**
Commitment to Financial Efficiency and Continuous Improvement targets, as required
Commitment to improving NPS (customer) scores based on overall Operations goals
Commitment to the achievement of the divisional and organizational Strategic Priorities
**Required Qualifications:**
Post-secondary education or an equivalent combination of education and relevant experience.
2-3 years of experience in a customer-focused environment, case management, claims, or a related field.

Proficiency with Microsoft Office 365 applications.

Experience in Group Benefits, claims management, disability management, insurance, or another regulated setting.

Knowledge of benefits administration, medical and dental terminology, or claims-related practices.
**Preferred Qualifications:**




Excellent written and verbal communication skills with the ability to interact effectively with a variety of stakeholders.

Strong analytical, problem-solving, and decision-making skills.

Proven ability to manage multiple priorities in a fast-paced and evolving environment.

Strong attention to detail, sound judgment, and commitment to maintaining confidentiality.

Ability to work independently while collaborating effectively within a team environment.

Experience investigating complex cases, assessing risk, and resolving challenging situations.

Strong customer focus with the ability to build productive relationships with a wide range of stakeholders.

Strong influencing, negotiation, collaboration, and communication skills.

Ability to adapt to change, embrace new technologies, and manage competing priorities effectively.

Continuous improvement mindset with a focus on operational excellence and solution-oriented thinking.

Experience serving as a subject matter expert, mentor, or informal leader is considered an asset.
**Working Conditions:**
Work

Smart is an option for this role
Work hours aren't always “traditional” and coverage may need to align with Customer Contact Centre to provide optimal customer service
Overtime to maintain service levels is a requirement of the role
**When you join our team:**
We'll empower you to learn and grow the career you want.

We'll recognize and support you in a flexible environment where well-being and inclusion are more than just words.

As part of our global team, we'll support you in shaping the future you want to see.
**#LI-REMOTE**
The role being advertised is an existing vacancy.
**Acerca de Manulife y John Hancock**
Manulife Financial Corporation es un importante proveedor internacional de servicios financieros que ayuda a las personas a tomar decisiones de una manera más fácil y a vivir mejor.

Para obtener más información acerca de nosotros, visite
http://www.manulife.com .
**Manulife es un empleador que ofrece igualdad de oportunidades**
En Manulife/John Hancock, valoramos nuestra diversidad.

Nos esforzamos por atraer, formar y retener una fuerza laboral tan diversa como los clientes a los que prestamos servicios, y para fomentar un entorno laboral inclusivo en el que se aprovechen las fortalezas de las culturas y las personas.

Estamos comprometidos con la equidad en las contrataciones, la retención de talento, el ascenso y la remuneración, y administramos todas nuestras prácticas y programas sin discriminación por motivos de raza, ascendencia, lugar de origen, color, origen étnico, ciudadanía, religión o creencias religiosas, credo,



sexo (incluyendo el embarazo y las afecciones relacionadas con este), orientación sexual, características genéticas, condición de veterano, identidad de género, expresión de género, edad, estado civil, estatus familiar, discapacidad, o cualquier otro aspecto protegido por la ley vigente.

Nuestra prioridad es eliminar las barreras para garantizar la igualdad de acceso al empleo.

Un representante de Recursos Humanos trabajará con los solicitantes que requieran una adaptación razonable durante el proceso de solicitud.

Toda la información que se haya compartido durante el proceso de solicitud de adaptación se almacenará y utilizará de manera congruente con las leyes y las políticas de Manulife/John Hancock correspondientes.

Para solicitar una adaptación razonable en el proceso de solicitud, envíenos un mensaje a
[email protected] .
**Referenced Salary Location**
Waterloo, Ontario
**Modalidades de Trabajo**
Híbrido
**Salary range is expected to be between**
$43,875.00 CAD - $73,125.00 CAD
Los empleados también tienen la oportunidad de participar en programas de incentivos y recibir una compensación vinculada al rendimiento empresarial e individual.

El salario real variará según las condiciones del mercado local, la geografía y factores relacionados con el puesto como conocimientos, habilidades, requerimientos, experiencia y educación/formación.

Si solicitas este puesto fuera de tu ubicación principal, por favor escríbenos a
[email protected]
para conocer el rango salarial correspondiente a tu ubicación.

Manulife ofrece a los empleados aptos una amplia variedad de beneficios personalizables, entre ellos, beneficios de salud, odontológicos, de salud mental, oftalmológicos, por discapacidad a corto y a largo plazo, cobertura de seguro de vida y por muerte accidental y desmembramiento, adopción/subrogación y bienestar, y planes de asistencia al empleado/familiar.

También ofrecemos a los empleados admisibles varios planes de ahorro para la jubilación (incluidos planes de pensiones y un plan mundial de propiedad de acciones con contribuciones equivalentes del empleador) y recursos de asesoramiento y educación financiera.

Nuestro generoso programa de tiempo libre remunerado en Canadá incluye feriados, vacaciones, días personales y días por enfermedad, y ofrecemos la gama completa de ausencia laboral reglamentaria.

Si se está postulando para este puesto en los EE. UU., póngase en contacto con
[email protected]
para obtener más información sobre las disposiciones relativas al tiempo libre remunerado específicas de EE. UU.

We use data and analytics technologies, such as artificial intelligence (AI), and automated processing tools, to analyze and process the information you provide to us or third parties in the application process.

For more information, please refer to our personal information collection statement (https://careers.manulife.com/global/en/talentacquisitionprivacystatement) .

📌 Drug Prior Authorization Case Manager (Montreal)
🏢 Manulife
📍 Montreal