Claims Head

Sun Life Financial

Manila City, Metro Manila Taguig City, Metro Manila
Permanent
Full-time

2 months ago

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.Job Description:Major Accountabilities:1. Appraises all types and level of claims. May refer highly ambiguous claims to one or more of the following particularly for potentially contentious denials: the Chief Administration Officer, Legal, Underwriting, Medical. May also consult with Sales on group claims with account management implications.2. Establishes claim policy & guidelines. Defines and sets standards of accuracy, timeliness and productivity, and develops strategies and plans to meet these standards. Reviews and revises claims guidelines to ensure that they are appropriate to market, legal and regulatory environments, and product design.3. Determines, obtains and allocates resources required to meet objectives, including budget, personnel, etc4. Manages the performance of Claims Manager and Claims Supervisor. Develops management and claims appraisal capabilities. Regularly reviews career development profiles, claim approval limits and training programs to ensure that the function keeps up with market and business requirements.5. Determines and implements projects for the streamlining of operations or improvement of servicing capabilities6. Determines what types of seminars to conduct, based on an analysis of agent and market needs, and directs the design of these seminars.Core Professional/Technical Competencies RequiredAbilities:

Assess major/critical legal and industry issues on claims with high ambiguity and exposures to the company
Calculate claims benefits
Apply complicated theory and fundamentals of claims appraisal
Apply Insurance Code, Family Code, Civil Code & Rules of Court and any bodies of law in variety of complicated claims scenarios

Knowledge:

In-depth knowledge of insurance concepts, principles and terminology
In-depth knowledge of claims concepts, principles and procedures
In-depth knowledge of legal issues related to claims (general and local laws)
In-depth knowledge of medical terminology and information
In-depth knowledge of products offered by Sun Life Financial
In-depth knowledge of customer service concepts and principles
In-depth knowledge of underwriting concepts, principles and general procedures
In-depth knowledge of management principles
In-depth knowledge of procedures for responding to customer complaints about claims
In-depth understanding of Sun Life Financial’s claim philosophy
In-depth understanding of Sun Life Financial’s standard of ethics
ACS designation
ALHC designation
FLHC designation
FLMI designation

Core Soft/Transferable Competencies

Collaborates effectively : Expert
Communicates confidently : Expert
Focuses on the customer : Expert
Takes accountability : Expert
Understands the business : Expert
Attracts, develops & retains talent : Expert
Builds & applies self-insight : Expert
Drives for action : Expert
Embraces differences : Expert
Generates innovative solutions : Expert
Leads change : Expert
Manages complexity : Expert
Thinks & acts strategically : Expert
Presentation Skills : Expert
Negotiation Skills : Expert

Development/Training to support Role CompetenciesRelevant Courses-Professional/Technical CompetenciesAsia Leadership ProgramManagement Effectiveness ProgramLOMA 351 - Financial Services EnvironmentLOMA 356 - Investment Principles and Institutional InvestingLOMA 361 – Insurance Company AccountingAIRC 410 - Regulatory compliance: Companies, Producers, and OperationsProfessional, Customer Service (PCS) designationFellow, Life Management Institute (FLMI) designationFellow, Life and Health Claims (FLHC) designationEducation and Experience:Minimum typical educationUniversity degree with major in Business, Accounting or other related disciplinesMinimum typical experience15 years of which 8 years are at managerial positions; expert level in life/insurance claims and in managing large team of people within large organization environmentJob Category: Claims - Life & DisabilityPosting End Date: 30/12/2024

Sun Life Financial

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