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Sr. Disability Claim Specialist

MANULIFE FINANCIAL

Toronto, ON, CANADA
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If you are the type of person who thrives on change, growth and opportunity, and are interested in a career in the financial services industry, Manulife is the place for you.

 

  

Sr. Disability Claim Specialist-1400185
 

Description

 

Using their extensive knowledge and expertise in the claims and legal process, this person is responsible for proactive and effective management and sound resolution of litigation claims while maintaining the integrity and best interest of all parties.  This role is responsible for identifying and assessing risk to the organization posed by practices and procedures, contract languor, litigation environment and providing recommendations to minimize these risks.  This person would represent the Company in litigation processes (mediations, Discoveries, arbitration, etc)

They would also be a technical expert in Disability Claims and provide assistance to Plan Sponsors, claim team members, Marketing/Product and other parties, as required.

 

Key Accountabilities:

  • Analyze the merits of the claim and determine the appropriate course of action in its defence, contemplating alternate cost effective methods of resolving the dispute, taking into account the weakness of the case
  • Manage litigation claims by collaborating with Counsel ensuring controls are maintained and cases moved forward at an acceptable pace while continuing to assess the risk and exposure.  Review litigation reserves, complete litigation reports and provide monthly updates.
  • Represent the Company on litigated claims by attending Examinations for Discovery, mediations, arbitrations and Trials.
  • Represent the department in presentations to the field and on projects which impact the department.  Provide advice and feedback to Marketing/Product on claim related matters; including review of policy provisions.
  • Respond to inquiries from Plan Sponsors and agents, including hypothetical claim inquiries.
  • Following the published Audit Criteria, conduct random DI claim audits on a monthly basis and conduct focused audits when required.  Maintain ongoing documentation of results on an individual basis in order to facilitate identification of trends and assess development and expertise of the claim Specialists.  Identify training needs and make recommendations for individual & departmental training to Management.
  • Contribute to the establishment of Department guidelines and claim evaluation criteria.  Seek opportunities to obtain new information and maintain up-to-date knowledge of the insurance industry, including other areas of the Company
 

Qualifications

 

Job Requirements (Education, Experience, Knowledge, Skills and Competencies):

  • 10+ years of experience in managing DI & CI claims utilizing sophisticated adjudication tools.
  • Proven and exceptional customer service oriented individual with strong negotiation & dispute resolution skills.
  • Thorough knowledge of medical conditions/terminology & sound interpretation of financial documents & understanding of fair claim practices.
  • Must demonstrate exemplary decision making skills even with conflicting/incomplete information to manage conflicts decisively and effectively while minimizing cost and exposure to the Company.
  • Thorough understanding of contract interpretation & ability to convey decisions.  Communications require a strong command of the language at a heightened level where complex issues can be explained with precision & clarity.
  • Personal style must reflect high degree of professionalism in order to promote respect for Department & Company values.
  • Excels at responding constructively and decisively in high pressure/emotional situations & responding positively to change & making decisions under pressure in ambiguous or complex situations.
  • Must have a strong/thorough knowledge of government legislation and legal precedents, the Insurance Act and/or Quebec Civil Code.
  • Ability to clearly articulate the decision and handle the pressure of representing the Company during legal proceedings.
  • Strong relationship management skills provide the ability to influence and negotiate while maintaining positive & effective relationships with internal & external stakeholders
  • Ability to influence, convince, direct and persuade team members in achieving high levels of performance
Key Problems/Challenges:
  • Ability to assess the risk & exposure in both the pre and post litigation stage and determine the best course of action
  • Testify at legal proceedings, under oath.
  • Assess appropriate settlement offers, provide authority to in-house counsel up to $100K and act in conjunction with counsel to negotiate settlement.
  • In cases where it is determined that the claim is invalid, all necessary documentation must be secured to support the decision to the extent that it would satisfy a Court.  In cases where the matter Is unclear, a compromise must be reached, using extra contractual settlements or rehabilitation.
  • Understand the "gray" area in which entitlement may exist in relation to the terms and conditions of a particular policy contract and the complexity of how multiple and/or subjective medical conditions may impact occupational duties in order to make decisions on claims.  Examples of complex issues include legal disabilities & residual claims under own occupation policies.
  • Understand and interpret the contract provisions of products currently sold by Manulife and plans which were acquired, and apply the interpretation to the claims.
  • Understand & interpret financial documentation, including, personal and corporate tax returns, Notices of Assessment, financial statements, partnership agreements, etc.  In addition, there needs to be an understanding of how certain financial arrangements such as contingency fees, referral fees, retainers, locums' income, etc. affects the issuance of monthly benefits and our liability.

Scope (Dimensions & Organizational Impact):

  • Financial Impact:  DI/BOE claim reserves as at Dec. '12 amounted to $31.6 M. 
  • Claim decisions may be challenged through the legal process which could jeopardize the Company's reputation and subject us to damage awards.
  • Resolve the litigation in the best interest of all parties and protect the Company from jurisprudence from a financial and public image perspective.
  • This position has a direct impact on the Company's profitability and pricing of products
  • Claims experience is directly affected by the quality of claims adjudication; denying claims according to the terms of the policy, detecting fraudulent claims, identifying "red flags", thoroughly investigating claims, making appropriate claim decisions and settlements based on the policy and the circumstances surrounding the claim are all essential components of the adjudication process.
  • Claims adjudication by its very nature requires respect for confidentiality on the part of the Adjudicator.  A breach of confidentiality could jeopardize the Company's reputation and subject it to damages.
  • Authorization limit is a monthly benefit of $15K for 6 months for Disability claims, $150K for CI & Life WP claims and $5K for claim expenses.
  • The majority of insureds are self-employed professionals; the Plan Sponsors are high profile & advocates for their members.  The members can be intimidating by the very nature of their profession which makes these claims challenging.
About Manulife Financial

Manulife Financial is a leading Canada-based financial services group with principal operations in Asia, Canada and the United States. Clients look to Manulife for strong, reliable, trustworthy and forward-thinking solutions for their most significant financial decisions. Our international network of employees, agents and distribution partners offers financial protection and wealth management products and services to millions of clients. We also provide asset management services to institutional customers. Funds under management by Manulife Financial and its subsidiaries were C$567 billion (US$539 billion) as at June 30, 2013. The Company operates as Manulife Financial in Canada and Asia and primarily as John Hancock in the United States.

 

Manulife Financial Corporation trades as 'MFC' on the TSX, NYSE and PSE, and under '945' on the SEHK. Manulife Financial can be found on the Internet at manulife.com


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