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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive experience in claims risk management and adjudication, with a strong ability to leverage data analytics for risk assessment and decision-making. Proven track record in building partnerships across various stakeholders and providing independent oversight in a global environment.
Highest-signal resume keywords
Claims Risk ManagementClaims Adjudication PracticesData AnalyticsRelationship ManagementBilingual (French)
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims Risk ManagementClaims AdjudicationRisk Management PrinciplesData AnalyticsGovernance FrameworksInternal Control EnvironmentsRisk JudgmentMetrics ReportingEmerging Risk IdentificationComplex Claims Review
Soft Skills
Presentation SkillsRelationship ManagementIndependent ChallengeCollaborationInfluencing Skills
Certifications & Qualifications
FLMIFLHCCRM
Industry Keywords
Life InsuranceHealth InsuranceDisability InsuranceRegulatory DevelopmentsClaims PracticesRisk OversightStakeholder EngagementContinuous ImprovementEmerging RisksGlobal Business Units
About the role
Key responsibilities & impact- Provide independent oversight of claims risk management practices across Sun Life’s global business units
- Ensure alignment with Enterprise Insurance Risk Policy, Claims Operating Guideline, and other governance standards
- Lead risk validation testing and monitoring programs to assess claims controls
- Identify emerging risks and support continuous improvement in claims adjudication and risk management
- Leverage claims data, analytics, and key risk indicators to identify trends and evaluate risk exposures
- Provide actionable insights to support decision-making and strengthen risk oversight
- Partner with Claims, Underwriting, Medical, Risk, Compliance, Legal, Actuarial, and other global stakeholders
- Provide guidance and effective challenge on complex claims, emerging risks, strategic initiatives, and new technologies
- Research emerging industry trends, regulatory developments, and leading claims practices
- Represent Sun Life in industry associations, forums, and working groups as appropriate
Requirements
What you’ll need- 10+ years of progressive experience in Life, Health, or Disability claims adjudication, claims risk management, or a related field
- Deep understanding of claims adjudication practices, risk management principles, governance frameworks, and internal control environments
- Experience reviewing complex, high-value, or high-risk claims and applying sound risk judgment
- Experience influencing and building partnerships across Claims, Underwriting, Medical, Risk, Legal, Compliance, and senior business stakeholders
- Ability to provide independent, constructive challenge to first line recommendations
- Ability to use data, reporting, metrics, and trends to identify emerging risks and support decision-making
- Strong presentation and relationship management skills
- Experience leading initiatives, managing competing priorities, and delivering results in a global, collaborative environment
- Bilingual (French) is an asset
- Professional designations such as FLMI, FLHC, CRM, or other relevant insurance or risk management credentials are an asset
- For Quebec positions, bilingualism in French and English, both oral and written, is required
Benefits
Comp & perks- Opportunity to work with passionate colleagues and empowering leaders
- Professional growth and development support
- Sabbatical Program offering up to 6 weeks off every five years
- Care Days for self-care or care of others
- Sick Days
- Hybrid work flexibility from the office and virtually
- Incentive plans for eligible employees, subject to individual and company performance
- Workplace accommodation support for persons with disabilities