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.

Claims

Adjudication & Prior Authorization Management (60%) 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. 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. Commitment to Financial Efficiency and Continuous Improvement targets, as required Commitment to improving NPS (customer) scores based on overall Operations goals 2-3 years of experience in a customer-focused setting, 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 environment. ~ Knowledge of benefits administration, medical and dental terminology, or claims-related practices.

Experience investigating complex cases, assessing risk, and resolving challenging situations. Robust customer focus with the ability to build productive relationships with a wide range of stakeholders. 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. 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.

We'll recognize and support you in a flexible environment where well‐being and inclusion are more than just words. LI-REMOTE Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. 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. 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.

Referenced Salary Location

Waterloo, Ontario Working Arrangement Hybrid Salary range is expected to be between $43,875.00 CAD - $73,125.00 CAD Employees also have the opportunity to participate in incentive programs and earn incentive compensation tied to business and individual performance. 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. com for the salary range for your location. dental short- and long‐term disability life and AD&D; insurance coverage adoption/surrogacy and wellness benefits 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. 2026 Gallup Exceptional Workplace Award Winner ~ Financial Times World's Best Employers Asia-Pacific 2026 ~ To receive our latest job opportunities directly to your inbox, create an account or sign in and navigate to the 'Job Alerts' section located in the top right corner of the page.

Our ambition is to be the number one choice for customers.

📌 Drug Prior Authorization Case Manager (Alton)
🏢 Manulife/John Hancock
📍 Alton