Senior Claims Manager, Medical Pre-Approval & QA

Sunlife; Hong Kong; On-site; HKD 600,000 - 1,000,000; Full time

Benefits offered by this job

5-day work week

MPF

Group life insurance

Group medical insurance

Job summary

Sun Life Hong Kong is seeking an experienced claims professional to lead pre-approval medical services, oversee junior assessors, and establish cost/quality control guidelines for efficient processing. The role requires making informed decisions on complex claims and coordinating with TPAs to optimize workflows.

Applicants should have a university degree in business or healthcare administration, at least five years in life insurance claims with two years in a managerial role, and strong

Qualifications

• Must have quality assurance experience in life insurance claims.
• Experience leading teams and training junior staff.
• Strong data analysis and reporting capabilities.

Responsibilities

• Manage pre-approval medical claims to ensure timely settlements.
• Handle complex/high-value claims and provide recommendations.
• Develop medical cost and quality control standards for claims processing.
• Provide guidance and training to junior claims assessors.
• Ensure regulatory compliance and internal policies.
• Collaborate with TPAs to resolve issues and improve processes.

Skills

Leadership

Data analysis

Quality assurance

Medical terminology

Regulatory knowledge

Education

University degree (business / healthcare admin)

Job description

Sun Life Hong Kong is seeking an experienced claims professional to lead pre-approval medical services, oversee junior assessors, and establish cost/quality control guidelines for efficient processing. The role requires making informed decisions on complex claims and coordinating with TPAs to optimize workflows.

Applicants should have a university degree in business or healthcare administration, at least five years in life insurance claims with two years in a managerial role, and strong