Senior Manager, Stop Loss Claims
Responsible for the supervision of a claims unit, including directing the evaluation, investigation, negotiations, and settlement of complex claims department(s). Ensures that all legitimate claims and benefits are paid as quickly as possible, keeping the interest of both policy owners and the company in proper balance.
- Plans and directs the work of Claims unit personnel, including directing work assignments, scheduling and reviewing work-in-progress. Monitors work flow to ensure continued prompt and accurate claims service.
- Supervises staff, with responsibility for hiring, performance management, and coordinating training and development.
- Reviews and handles all problem, complex, or special claims cases and settles or initiates further action within approved authority limits, ensuring that policyholders are treated fairly and equitably and that the terms and policies are in compliance with state and federal laws.
- Represents Sun Life to outside agencies, such as third party administrators, brokers/agents, policyholders vendors, and outside counsel to ensure continued good relations and image of Sun Life which leads to policyholder satisfaction and new and renewed business.
- Is considered a leader/expert within the department. Takes the initiative to problem solve as needed. This might include educating the field force and marketing department on claim philosophy and collaborating with the Senior Leadership team.
- Identifies problem areas and develops, implements and evaluates procedures to correct the problem which will lead to more accurate, prompt claims service to the policyholder, increase the overall effectiveness and efficiency of the unit and ensure uniformity and consistency in all procedures.
- Ability to review various department's reports and communicate results and trends.
- Requires ability to understand state and federal laws as they apply to claims practice and detailed knowledge of most claims practices and accounting.
- Recognizes the value of professional networking and idea sharing within the industry and has presented to peers or has sat on panels in industry meetings.
- Demonstrated ability to effectively communicate and negotiate to achieve results through influencing others within the department/ organization, both bottom up and top down
- Superior knowledge of Stop Loss and associated computer systems.
- Eight to ten years experience in claims with four to five years of management experience.
- Sun Life Financial is an equal employment and affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status or any other characteristic protected by law. Sun Life Financial is committed to building a diverse and inclusive company culture.