Claims Verification Analyst

at  Manulife

We are a leading financial services provider committed to making decisions easier and lives better for our customers and colleagues around the world. From our environmental initiatives to our community investments, we lead with values throughout our business. To help us stand out, we help you step up, because when colleagues are healthy, respected and meaningfully challenged, we all thrive. Discover how you can grow your career, make impact and drive real change with our Winning Team today.

RESPONSIBILITIES

• Reviews audit evidence submissions by plan members to authenticate information, identifies areas of concern, actions issues for resolution, and obtains/requests additional evidence required on suspect claim submissions.
• Validates irregular Internet transaction activity through phone call interviews with providers and/or plan members and secures evidence on discrepancies as part of information gathering on suspect claim submission activity. Requests supporting documentation from plan members and authenticates information, identifying issues and gaps for further review and resolution.
• Identifies fraudulent claims, documents and gathers evidence, and supports ongoing management of investigation activity
• Confirms provider licensing credentials and legitimate business establishments through Internet searches and by contact with professional associations and colleges. Actions and resolves issues for successful audit outcomes and escalates key provider control issues to the e-commerce control management team
• Analyzes data to identify anomalies, trends and patterns; and supports testing, and documentation of new risk controls for continuous review of all Internet submission activitySupports awareness on e-commerce control and operational workflow issues by providing direction and information to internal Group Benefit departments such as Call Center and various Health and Dental Operation departments