Claims Manager

This role supports effective claims management through complex and major claims handling, involving overseeing junior case reviews and establishing medical cost/quality control guidelines as well as communicating with channels on claims initiatives.

Responsibilities

• Handle and assess complex claims, including cases requiring escalation or further review.
• Manage claims appeals and complaints, ensuring appropriate review, follow-up, and resolution.
• Communicate with distribution channels and relevant stakeholders on claims enquiries, issues, and updates.
• Manage mini projects and claims-related initiatives, coordinating with relevant parties to support implementation.
• Conduct market intelligence and benchmarking to identify market practices, trends, and insights relevant to claims.
• Drive operational efficiency by identifying process improvements and opportunities to streamline claims operations.

Requirements

• University degree, preferably in business, healthcare administration or related discipline
• Minimum 5+ years relevant life insurance claims experience, with at least 2 years in managerial role and TPAs relationship management experience
• Excellent leadership skills
• Proficiency in data analysis and reporting
• Strong communication and interpersonal skills
• With quality assurance experience
• Knowledge of medical terminology and procedures
• Knowledge of regulatory requirements and compliance standards in the insurance industry

At Sun Life, we offer a 5-day workweek, attractive salary, MPF, group life and group medical insurance, and excellent career development opportunities.