Manager I, Claims Services

Reposted Yesterday
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Hung Hom, Kowloon City, HKG
In-Office
Senior level
Fintech • Payments • Financial Services
The Role
Manage pre-approval (cashless) medical claims, oversee junior assessors, handle complex high-value cases, develop medical cost and quality-control standards, ensure regulatory compliance, and collaborate with TPAs to optimize processes.
Summary Generated by Built In

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:

This role will specialize in pre-approval medical services (cashless claims), involve overseeing junior case reviews and establish medical cost/quality control guidelines as well as collaborate with Third-Party Administrators (TPAs) to optimize processes.

Responsibilities

  • Manage pre-approval medical claims to ensure timely and accurate claim settlements

  • Handle complex and high-value claims, making decisions and recommendations as needed

  • Develop medical cost and quality control standards to improve claims processing efficiency

  • Provide guidance, training, and support to junior claims assessors to ensure high performance

  • Ensure compliance with regulatory requirements and internal policies

  • Collaborate with TPAs to resolve claims-related issues and identify process improvement

Requirements

  • University degree, preferably in business, healthcare administration or related discipline

  • Minimum 5+ years relevant life insurance claims experience, with at least 2 years in managerial role and TPAs relationship management experience

  • Excellent leadership skills

  • Proficiency in data analysis and reporting

  • Strong communication and interpersonal skills

  • With quality assurance experience

  • Knowledge of medical terminology and procedures

  • Knowledge of regulatory requirements and compliance standards in the insurance industry

We offer 5-day work, attractive salary, MPF, group life and group medical insurance; and excellent career development opportunities to the right candidate.

We are an equal opportunity employer and welcome applications from all qualified candidates. Application forms and resume will be kept for a period of 24 months after completion of the recruitment process. (All information will be held in strict confidence and only be used for recruitment purpose).

Job Category:

Claims - Life & Disability

Posting End Date:

29/04/2026
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The Company
Toronto, Ontario
499 Employees

What We Do

A UK company, Sun Life Financial of Canada is focused on building excellent customer service by offering the highest levels of customer care. We have been serving customers in the UK for over 100 years

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