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Manulife

Drug Prior Authorization Case Manager

Halifax, NS, Canada
Kitchener, ON, Canada
Toronto, ON, Canada
Waterloo, ON, Canada
Montreal, QC, Canada

$43,875.00 CAD - $73,125.00 CAD · Full-time

Apply About employer

Applications open in a new tab.

Job details

Pay: $43,875.00 CAD - $73,125.00 CAD
Job type: Full-time
Apply by: Oct 12, 2026
Experience: 2-3 years of experience in a customer-focused environment, case management, claims, or a related field.
Posting language: English
Posted: Oct 2, 2026

Original job description

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 environment.

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:

WorkSmart 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.

The role being advertised is an existing vacancy.

About Manulife and John Hancock

Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better. To learn more about us, visit https://www.manulife.com/en/about/our-story.html.

Manulife is an Equal Opportunity Employer

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.

It is our priority to remove barriers to provide equal access to employment. A Human Resources representative will work with applicants who request a reasonable accommodation during the application process. 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. To request a reasonable accommodation in the application process, contact hr@manulife.com.

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. If you are applying for this role outside of the primary location, please contact hr@manulife.com for the salary range for your location.

Manulife offers eligible employees a wide array of customizable benefits, including health, dental, mental health, vision, short- and long-term disability, life and AD&D insurance coverage, adoption/surrogacy and wellness benefits, and 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. If you are applying for this role in the U.S., please contact hr@manulife.com for more information about U.S.-specific paid time off provisions.

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.

Apply About employer

More about this job

Responsibilities

The Case Manager is responsible for the end-to-end management of complex drug prior authorization claims, including adjudication and direct communication with stakeholders. They also serve as a subject matter expert to support internal teams, provide training, and contribute to operational effectiveness and quality improvement initiatives.

Requirements

Candidates must have post-secondary education and 2-3 years of experience in customer-focused environments, claims management, or related fields. Proficiency in Microsoft Office 365 and knowledge of benefits administration or medical/dental terminology are required.

Skills

Claims adjudication
Prior authorization
Case management
Risk management
Analytical skills
Problem-solving
Decision-making
Communication skills
Negotiation
Customer service
Microsoft Office 365
Benefits administration
Medical terminology
Dental terminology
Attention to detail
Mentoring

Benefits

Health insurance
Dental insurance
Mental health support
Vision insurance
Short-term disability
Long-term disability
Life insurance
AD&D insurance
Adoption/surrogacy benefits
Wellness benefits
Employee assistance plan
Retirement savings plans
Pension plan
Global share ownership plan
Paid time off
Statutory leaves of absence

Visa sponsorship

Not detected in the job text

Keywords

Drug Prior Authorization
Claims Adjudication
Case Management
Group Benefits
Disability Management
Insurance
Risk Management
Customer Experience
NPS
Operational Excellence
Microsoft Office 365
Medical Terminology
Dental Terminology
Stakeholder Management
Continuous Improvement
Quality Assurance
Data Analysis
Regulatory Environment
Mentorship
Conflict Resolution
Negotiation
Strategic Priorities
Financial Efficiency
WorkSmart
Customer Contact Centre

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