Manager, Travel Claims Vendor Risk & Oversight

Manager, Travel Claims Vendor Risk & Oversight

Travel Claims is changing the way it works. Over the next nine months the way a travel claim is received, routed, reviewed and audited is being redesigned and part-automated through our delivery partner, and Travel Claims is one of three areas of the business in scope. At the same time the volume of secondary reviews coming into the team has roughly doubled inside a year. We are looking for a manager who can run a team of experienced claims professionals through that change and come out the other side with a faster process, better decisions and a team working in a genuinely different way.

This role leads the Travel Claims Risk Management Team, the group that handles our highest-value, most sensitive and most complex claim decisions. Much of the claim handling behind those decisions sits with a third-party administrator, so a central part of the job is second-line oversight of that vendor: setting the control expectations, testing whether they are being met, and escalating when they are not. The role is also the business owner for the Travel Claims part of the transformation programme and the person who owns what the team's numbers say. It is deliberately built with more scope than the job it replaces, and it is a natural development role for someone ready to grow into a director position.

Reports to the Director, Affinity Claims, Canada Segment. Leads a team of eight covering high-risk medical and non-medical claims, denials, appeals, sensitive and escalated files, legal and media threats, regulatory inquiries and large-loss oversight. Works closely with the Audit and Operations team and shares the audit and recovery agenda with it. Represents Travel Claims to our third-party administrator, to the transformation programme and to the Affinity Operations leadership team and works with first- and second-line risk, compliance and vendor management colleagues on the oversight of that administrator.

We expect the person in this role to model a different way of working rather than simply manage through the change. That means building your own view of the work instead of requesting a report, testing an idea in a short cycle and showing the result rather than writing a paper about it, making the case for a change in numbers that the team and the executive can both check, using AI as part of everyday work with a clear view of where human judgement stays, and holding a position with a delivery or outsourcing partner when the evidence supports it.

Position Responsibilities:

·Claim decisions and medical case management

oLead the review of high-value and complex travel claims, working within the approval authorities set for the business, and make or endorse the decision on files that carry financial, regulatory or reputational weight. Set the standard for the written reasoning behind a decision, particularly where a review changes an earlier outcome. Manage the flow of work so the oldest and highest-value files are the ones being worked and keep the team's open inventory visible and current. Act as the escalation point for claimant complaints, legal and media threats and regulator enquiries that reach the team.

·Audit, quality and recoveries

oPartner with the Audit and Operations team on the monthly audit programme covering both Affinity and Group Benefits travel business. Turn audit findings into process change rather than only file correction, feeding themes into training, into the administrator's handling standards and into the automation backlog. Own the connection between what audit identifies and what is actually recovered and establish the recovery baseline the business does not have today. Contribute to annual audit cycles including licensing, case fee and recovery reviews.

·Data, reporting and insight

oRun the team on evidence. Build and maintain a live view of intake, time waiting before assignment, active review time, open work by age and value, overturn rates and audit findings, refreshed automatically rather than assembled by hand each month. Do this work personally rather than waiting on a reporting request. Make sure every figure the team publishes can be traced back to a source that somebody else can open and check and bring that analysis to monthly operating reviews and executive discussions.

·Transformation, AI and automation

oAct as the business owner for the Travel Claims scope in the transformation programme. Write and prioritise the backlog, define what ready and done mean for this team's process, take part in programme planning, run the fortnightly demonstrations, and sign off testing, go-live and the settling-in period. Lead the assessment of tools that remove manual effort from a file, including medical record summarisation. Agree with our administrator where automation can handle low-value, low-risk claims and secondary reviews end to end, and what level of error is acceptable when it does. Keep a clear and stated position on where a person must remain in the decision.

·Vendor risk oversight and governance

oOwn the risk and control oversight of the third-party administrator that handles travel claims on our behalf. Set and document the control expectations that apply to their handling of our files, including approval authorities and the escalation rules that sit around them, and test whether those controls are actually working rather than assuming they are. Run the governance rhythm: weekly and monthly operational forums, the quarterly and mid-year scorecards, and the annual reviews covering licensing, case fees and recoveries. Bring evidence rather than impressions to each of them.

Own the issue and corrective action pipeline for this vendor, from identifying a control gap through to closing it, and keep an honest, current view of the vendor's risk position that you can put in front of leadership, risk partners and auditors at short notice. Where the transformation programme introduces automation into the vendor's handling of our claims, extend the same discipline to it: agree what the controls are, agree what level of error is acceptable, and make sure the monitoring exists before anything goes live.

·People leadership

oLead, coach and develop a team of eight through a period in which several of their roles will change. Be straight with people about what automation changes and what it does not and move reviewers into higher-value work as routine work is taken out. Build the team's confidence with data and with AI tools, set clear performance expectations, and grow the bench beneath this role.

Required Qualifications:

• Post-secondary education in a business, health, analytics or insurance discipline, or an equivalent combination of education and experience.

• Five or more years leading a claims, risk or audit team, including leading people through a significant change to how the work is done.

• Strong technical grounding in travel or health claims and medical case management, with sound judgement on high-value and complex decisions.

• Demonstrated use of data to run an operation. Builds their own analysis, is confident in Excel and a reporting tool such as Power BI and can defend a number under executive challenge.

• Experience as a business owner, product owner or equivalent on a delivery programme, including backlog ownership, user acceptance testing and go-live decisions.

• Practical experience applying AI or automation tools to real operational work, with clear thinking on controls, error tolerance and where a person must stay in the decision.

• Proven vendor relationship management. Has owned a material outsourced or third-party relationship day to day, including performance conversations, remediation and holding a position without damaging the relationship.

• Proven risk, control and audit experience. Can define a control, test it, evidence a failure, write it up and see the remediation through to close. Comfortable working with first- and second-line risk partners and with internal and external audit.

• Strong vendor governance experience. Has run a governance framework over a supplier: service levels, scorecards, issue and corrective action tracking, and reporting the vendor's risk position upward with a clear view.

• Strong written and verbal communication, including presenting results and recommendations to senior leaders.

Preferred Qualifications:

• Experience taking a manual process to an automated one while holding or improving quality.

• Familiarity with fair treatment of customers expectations, complaint handling and regulator enquiries in a Canadian insurance setting.

• Familiarity with regulatory and internal expectations for outsourcing and third-party risk in Canadian financial services.

• Nice to have: Bilingual (French & English) - The successful candidate could have to also communicate in French to support clients from various jurisdictions including Quebec.

What success looks like

In the first year, the redesigned Travel Claims process is live, and the team is trained on it, the time a claimant waits for an answer has come down substantially, and the team is absorbing higher volume without added headcount. The control expectations on our third-party administrator are written down and tested rather than assumed, open issues have owners and closure dates, and the vendor's risk position can be explained to leadership or an auditor without a scramble. Audit findings feed process change every month, a recovery baseline exists where none did before, and the team's reporting refreshes itself.

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-HYBRID

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

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Referenced Salary Location

CAN, Ontario, Waterloo, 500 King Street NorthHybrid

Salary range is expected to be between

$85,300.00 CAD - $135,300.00 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.

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