Sr. Claim Processing Representative, DentaQuest

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

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: Looking for someone who lives in Oregon

The opportunity:
The Sr. Claim Processing Representative may specialize in one or more business units and are responsible for consistently processing advanced and complex claims with 99% or greater accuracy using proprietary claim processing software.

How you will contribute: 

• Consistently process advanced & complex claim queues with a 99% or greater accuracy rate.
• Uses business knowledge to resolve advanced claim processing scenarios including, but not limited to, COB (coordination of benefits), ORTHO (orthodontia) cases, TPL (third party liability), and manual pricing.
• Responsible for adjustments to complex claims, as necessary, to meet corporate goals.
• Process Direct Member Reimbursement claims, to include calling providers and members for missing information.
• Serve as back up to Claim administration team by processing adjustments, posting check refunds and completing follow ups
• Serve as back up to Claim Research and Resolution team by researching and resolving claim issues
• May serve as back up to Team Lead in daily reporting
• Successful completion of more complex projects, as assigned
• Perform other duties as requested

What you will bring with you:

• Associates degree and/or four years of experience in a business environment
• Strong math skills
• Previous claim processing experience required
• Attention to detail, accuracy and organization skills are essential
• Understanding of general insurance guidelines
• Ability to efficiently operate computer
• Strong interpersonal, written and verbal communication skills
• Self-motivation demonstrated by taking initiative to learn more and assume new challenges
• Cooperative, professional and effective interaction skills with co-workers, business partners and visitors
• Ability to work in excess of 40 hours in one week
• Ability to use Microsoft Office (Word, Excel and Outlook)
• Able to follow verbal and written instructions
• Ability to communicate in an active environment
• Ability to communicate via telephone or computer technology, via written and verbal channels

Salary:  $45,500 - 61,400
At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. 

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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive.  We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate.  We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation an