Risk Assurance Manager guiding AI assurance plans at PwC Australia. Collaborating on governance frameworks and risk management for responsible AI usage.
About the role
- Senior Claims Analyst managing complex claims for Health and Risk Solutions at Sun Life. Leading claims evaluation and mentoring team members in a hybrid work environment.
Responsibilities
- Manage overall claim risk, including decisions to pay/deny claims
- Develop and implement comprehensive action plans for complex Stop Loss claims
- Orchestrate timing of implementation of complex claims requiring multiple parties
- Recognize and monitor evolving medical and RX trends for responsive case management
- Establish policies and institutionalize practices
- Manage communications with policyholders, brokers, sales representatives, vendors, and internal partners
- Coach and mentor less experienced peers and provide training to new hires
- Manage accommodations advance payments claims
- Keep current with industry practices
Requirements
- Seven (7) plus years of experience handling complex claims, preferably in Stop Loss
- In depth grasp of highly complex claim practices and legal precedents
- Considerable judgment and initiative in making recommendations
- Deep understanding of state and federal healthcare legislation and laws as they apply to claims practice
- Subject matter expert in the industry with experience presenting to peers or sitting on panels in industry meetings
- Established network of peers within the industry to share ideas and new claim management techniques/processes
- Effective communicator, negotiator, and influencer
- Ability to execute complex written correspondence clearly and understandably
Benefits
- Health insurance
- Generous vacation and sick time
- Paid family, parental and adoption leave
- Company paid life and AD&D insurance
- Disability programs
- Partially paid sabbatical program
- 401(k) employer match
- Stock purchase options
- Employer-funded retirement account
- Flexible, inclusive and collaborative work environment
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