DentaQuest
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.
DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.
Job Description:
Location: We support US virtual working arrangements in the contiguous 48 states.
At Sun Life, we look for optimistic people who want to make life brighter for ourClients.We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work.Every day,you’ll be empowered and challengedbyworking withdynamic colleaguesto find new and innovative ways to make Sun Life the best benefits company in America.
The opportunity:
The Claims Administrator Associate may specialize in one or more business units and perform the highest level of processing. This role must use independent judgment and prior experience to accurately post refund checks, process complex follow ups that could not be resolved elsewhere and adjust claims to a final resolution. Accuracy of 99% or higher is required.
How you will contribute:
- Consistently process advanced & complex claim adjustments with a 99% or greater accuracy rate.
- Uses business knowledge to independently resolve advanced claim adjustment scenarios including, but not limited to, refunds, corrections, follow ups, coordination of benefits, orthodontia, check returns, retention and all outstanding claim issues.
- Makes adjustments to complex claims as necessary to meet corporate goals.
- Document work product and track outstanding items and turnaround times within Windward or other manual tracking tools such as excel spreadsheets.
- Work closely with providers, members and clients to properly resolve claim issues.
- Collaborate with members of sales, client services and provider relations to address outstanding claim issues.
- Communicate with leadership on claim trends to assist in proactively resolving broader claim issues.
- Work with management to increase auto adjudication rates and self-service utilization.
- Process map workflow and lead resolution of ad hoc scenarios.
- May serve as back up to call center during peak periods by taking provider and member calls to ensure corporate wide service levels are consistently achieved.
- Serve as back up to Claim Research and Resolution team by researching and resolving claim issues
- Other duties as needed or required.
What you will bring with you:
- Associates degree and/or Six years’ experience in a business environment.
- Strong math competency.
- Previous claim processing experience required.
- Attention to detail, accuracy and organization skills are essential.
- Understanding of general insurance principles. Independent and strategic decision making.
- Strong interpersonal, written and verbal communication skills.
- Self-motivation demonstrated by taking initiative to learn more and assume on more challenges.
- Cooperative, professional and effective interaction skills with co-workers, business partners and visitors.
- Ability to work in excess of 40 hours in a week.
- Ability to efficiently operate computer.
- Ability to use Microsoft Office. (Word, Excel and Outlook)
- Able to follow verbal and written instructions.
- Ability to read and comprehend at a high school level.
- Ability to communicate in an active office environment.
- Ability to sit for more than 90% of an 8 hour day.
- Ability to use basic office equipment and communicate via telephone or computer technology, by way of written and verbal channels.
- Required to attend additional training as requested/deemed necessary.
Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.
Not ready to apply yet but want to stay in touch? Join our talent community (https://pages.beamery.com/sunlifecareers/page/join-us-canada to stay connected until the time is right for you!
Life is brighter when you work at Sun Life
- Excellent benefits and wellness programs to support the three pillars of your well-being mental, physical and financial including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
- Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account
- A flexible work environment with a friendly, caring, collaborative and inclusive culture
- Great Place to Work Certified in Canada and the U.S.
- Named as a Top 10 employer by the Boston Globe’s Top Places to Work two years running
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
If you are a California resident, the salary range for this position is:
- Southern region: 46,300 – 62,500 annually
- Central region: 48,800 – 65,900 annually
- Northern region: 52,200 – 70,400 annually
If you are a Colorado resident, the salary range for this position is 44,200 – 59,600 annually.
If you are a New York resident, the salary range for this position is 52,200 – 70,400 annually.
If you are Washington resident, the salary range for this position is 48,8090 – 65,900 annually.
We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.