Claims Analyst — Impactful Insurance Claims & Growth

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

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.