Claims Head

locations Taguig City, National Capital Region (Manila)
time type Full time
posted on Posted 4 Days Ago
job requisition id JR********
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, etc
4. 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 capabilities
6. 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 Required Abilities: 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 Core Soft/Transferable Competencies Collaborates effectively : Expert Communicates confidently : Expert Focuses on the customer : Expert Takes accountability : Expert Understands the business : Expert Builds & applies self-insight : Expert Drives for action : 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 Competencies Relevant Courses-Professional/Technical Competencies
Management Effectiveness Program
LOMA 356 - Investment Principles and Institutional Investing
LOMA 361 – Insurance Company Accounting
AIRC 410 - Regulatory compliance: Companies, Producers, and Operations
Fellow, Life and Health Claims (FLHC) designation
Education and Experience:
Minimum typical education University degree with major in Business, Accounting or other related disciplines
Minimum typical experience 15 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 environment
Job Category:
Claims - Life & Disability 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, etc
4. 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 capabilities
6. 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 Required Abilities: 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 Competencies Relevant Courses-Professional/Technical Competencies
Asia Leadership Program
Management Effectiveness Program
LOMA 351 - Financial Services Environment
LOMA 356 - Investment Principles and Institutional Investing
LOMA 361 – Insurance Company Accounting
AIRC 410 - Regulatory compliance: Companies, Producers, and Operations
Professional, Customer Service (PCS) designation
Fellow, Life Management Institute (FLMI) designation
Fellow, Life and Health Claims (FLHC) designation
Education and Experience:
Minimum typical education University degree with major in Business, Accounting or other related disciplines
Minimum typical experience 15 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 environment
Job Category:
Claims - Life & Disability Posting End Date:
30/12/2024 Shine together At Sun Life, you can be your most brilliant self. Our supportive, flexible, and inclusive work environment is one where you – and your career – can thrive. Whatever your aspirations, collaborative leaders and colleagues are ready to help you learn, grow, and succeed.
We're a global company with a passion for people. Our purpose is to help Clients achieve lifetime financial security and live healthier lives. As a team of 30,000 across 26 countries, our impact is far-reaching, and locally relevant There's power in numbers. As part of Sun Life's growing team, you have an impact on people in your community and around the world.
Shape the future With an optimistic eye on a brighter future, we drive to innovate. Be part of leading change, push boundaries and try new ways of working. Use data to drive bold actions. Be agile and pivot as we test and learn. At Sun Life, we're driving transformation, sustainability and innovation for our Clients, employees, partners, and communities. Join us. Together, we can make the future brighter.
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