Claims Specialist

4 days ago


Taguig, National Capital Region, Philippines Sun Life Full time
About the Role

You will be an integral part of our team at Sun Life, working closely with colleagues who are experts in their fields. Your role will involve appraising and approving claims within prescribed approval limits, as well as performing initial reviews of claims that exceed these limits and submitting recommendations to your Manager for review and approval.

Key Responsibilities
  1. Appraise and approve death and living benefit claims within approval limits, securing input from Underwriting, Legal, and Medical teams when necessary.
  2. Prepare written analysis and recommended course of action for claims beyond authorized approval limits and submit to Manager for review and approval.
  3. Review and approve check requests within CAS approval limits and initially review and submit to Manager for approval those beyond CAS approval limits.
  4. Attend to claim inquiries ranging from basic to complex in nature, providing exceptional client service and support.
  5. Represent Sun Life in court hearings, as required, involving cases appraised within approval limits.
  6. Conduct learning sessions for the Claims Services Section, sharing knowledge and expertise with colleagues.
Requirements
  1. Graduate of any four-year course, preferably with a medical or legal background.
  2. Proficient in computer applications and systems.
  3. Strong analytical, judgment, comprehension, and conceptual thinking skills.
  4. Detail-oriented, organized, and systematic approach to work.
  5. Patient and interested in reading and familiarizing yourself with laws, regulations, and medical materials.
  6. Ability to work independently and make decisive decisions.
  7. Capacity to work under pressure, multitask, and prioritize tasks effectively.
  8. Excellent interpersonal relationship skills and a strong team player attitude.
  9. Above-average written and verbal communication skills in English.
  10. Willingness to pursue LOMA and ICA courses under the Claims Career Development Program.
  11. Good attendance and punctuality record.


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