Claims Specialist

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:

Overall Purpose:

Appraises and approves claims within prescribed approval limits, performs initial review of claims beyond authorized approval limits and submits recommended course of action to Claims Manager. Additionally, attends to claim inquiries ranging from basic to complex in nature.

Specific Accountabilities:

• Appraises and approves Individual and Group Death and Living Benefit claims within approval limits. Secures Underwriting, Legal, Medical input where necessary.
• Appraises claims beyond authorized approval limits, prepares written analysis and recommended course of action and submits to Claims Manager or Claims Head for review and approval or denial.
• Reviews and approves check requests within Disbursement approval limits and initially reviews and submits to Claims Manager or Claims Head for approval those beyond Disbursement approval limits.
• Attends claim inquiries ranging from basic to complex in nature.
• Represents Sun Life in Court or Insurance Commission hearings, as required, involving handled cases.
• Conducts learning sessions for Claims Services Section, as required.
  
  

Skills and Knowledge Required:

• Graduate of any four-year course. A medical/allied medical science or legal background would be an advantage.
• Computer literate (MS Word, Excel, various system applications).
• Highly skilled in data-driven decision making. Very good analytical, judgment, comprehension and conceptual thinking skills.
• Detail-oriented, organized, systematic.
• Patient and interested to read and familiarize self with provisions of the law, medical materials and review and scrutinize various documents.
• Able to work with minimal supervision.
• Effective at managing multiple priorities and capable of handling project responsibilities.
• Committed to providing excellent client service.
• Ability to build positive working relationships and work well in a team.
• With above average written and verbal English communication skills.
• Open to continuous learning and required LOMA and ICA certifications.
• With good attendance and punctuality record.
  
  

Job Category:

Claims - Life & Disability

Posting End Date:

03/07/2026