Claims Analyst

Sun Life of Canada (Philippines), Inc.; Taguig; Hybrid; PHP 420,000 - 640,000; Full time

Benefits offered by this job

Competitive salary package

Health and wellness benefits

Professional development opportunities

Structured career advancement

Work-life balance initiatives

Inclusive workplace culture

Job summary

Sun Life of Canada (Philippines), Inc. is seeking a Claims Analyst to join our dynamic Claims team in Bonifacio Global City, Taguig.

This full-time role focuses on processing, evaluating, and managing insurance claims with accuracy and efficiency while ensuring regulatory compliance and high-quality customer service. You will investigate claims, verify documentation, and determine claim validity, collaborating across departments to resolve issues and meet service level targets.

Qualifications

• Minimum of 2-3 years of experience in insurance claims processing or a related claims function.
• Bachelor's degree in a medical/allied medical science or legal background would be an advantage.
• Proficiency in claims management systems and relevant software applications; excellent communication in English.

Responsibilities

• Review, analyze and process insurance claims submitted by policyholders in accordance with policy terms and conditions
• Assess claim documentation and supporting evidence to verify eligibility and coverage requirements
• Investigate claims by contacting claimants, healthcare providers, and other relevant parties to gather necessary information
• Determine claim validity and authorize payment or denial of claims based on policy guidelines and findings
• Prepare detailed claim analysis reports and documentation for complex or disputed cases
• Identify and investigate potential fraudulent claims and escalate to the appropriate department
• Maintain accurate and comprehensive claim records in the company's management systems
• Communicate claim decisions to claimants in a professional and timely manner
• Handle customer inquiries regarding claim status and provide updates on outstanding claims
• Collaborate with healthcare providers, adjusters, and other departments to resolve claim-related issues
• Ensure compliance with company policies, procedures and applicable insurance regulations
• Monitor claim processing timelines and meet departmental performance targets and service level agreements

Skills

Analytical skills

Investigative skills

Communication in English

Organizational skills

Independent and team work

Education

Bachelor's degree in medical/allied medical science or legal background

Tools

Claims management systems

Regulatory compliance knowledge

Job description

At Sun Life, we cultivate a High-Performance, Caring Culture that empowers our people to achieve outstanding results, embrace continuous growth, and create meaningful impact. We succeed together by fostering an inclusive environment where wellbeing, collaboration, and accountability are equally valued.

About the role

Sun Life of Canada (Philippines), Inc. is seeking a Claims Analyst to join our dynamic Claims team. This is a full-time position based in Bonifacio Global City, Taguig City, Metro Manila. As a Claims Analyst, you will play a crucial role in processing, evaluating, and managing insurance claims with accuracy and efficiency. This position is integral to delivering exceptional customer service and ensuring compliance with all regulatory requirements and company policies. You will be responsible for investigating claims, verifying documentation, and making determinations that directly impact our customers' experiences and the company's operational excellence.

Key responsibilities

• Review, analyze and process insurance claims submitted by policyholders in accordance with policy terms and conditions
• Assess claim documentation and supporting evidence to verify eligibility and coverage requirements
• Investigate claims by contacting claimants, healthcare providers, and other relevant parties to gather necessary information
• Determine claim validity and authorize payment or denial of claims based on policy guidelines and findings
• Prepare detailed claim analysis reports and documentation for complex or disputed cases
• Identify and investigate potential fraudulent claims and escape suspicious activities to the appropriate department
• Maintain accurate and comprehensive claim records in the company's management systems
• Communicate claim decisions to claimants in a professional and timely manner
• Handle customer inquiries regarding claim status and provide updates on outstanding claims
• Collaborate with healthcare providers, adjusters, and other departments to resolve claim-related issues
• Ensure compliance with company policies, procedures and applicable insurance regulations
• Monitor claim processing timelines and meet departmental performance targets and service level agreements

What we're looking for

• Bachelor's degree in a medical/allied medical science or legal background would be an advantage.
• Minimum of 2-3 years of experience in insurance claims processing or a related claims function
• Strong knowledge of insurance policy terms, conditions, and coverage requirements
• Proficiency in claims management systems and relevant software applications
• Excellent analytical and investigative skills with attention to detail
• Outstanding written and verbal communication abilities in English; fluency in additional languages is advantageous
• Strong organizational skills and ability to manage multiple claims simultaneously
• Proven ability to work independently and as part of a team in a fast-paced environment
• Sound judgment and ethical decision-making capabilities
• Familiarity with health insurance claims and regulatory compliance requirements is preferred
• Professional certification such as Associate in Claims (AIC) or similar qualification is desirable

About us

Sun Life of Canada (Philippines), Inc. is a leading insurance and financial services provider committed to helping customers achieve their financial goals and protect what matters most to them. We are dedicated to delivering innovative insurance solutions, maintaining the highest standards of customer service, and fostering a workplace culture that values integrity, collaboration, and continuous improvement. With a strong presence in the Philippines and a reputation built on trust and reliability, Sun Life is an employer of choice that invests in the professional development and well‑being of our employees.

What we offer

• Competitive salary package commensurate with experience and qualifications
• Comprehensive health and wellness benefits.
• Professional development opportunities and training programs to enhance your skills and career growth
• Structured career advancement pathways within the Claims and Insurance divisions
• Work-life balance initiatives and flexible working arrangements where applicable
• Collaborative and inclusive workplace culture that values diversity and employee well-being