Member Advocate Specialist, DentaQuest South TX ( Bilingual in Spanish)

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:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.

**Candidates must be located in Cameron or Hidalgo County in Texas.

The opportunity: 

 The Member Advocate Specialist (MAS) has direct oversight for the advocacy of members included but not limited to preventive dental care, access to care, education, complaints and grievances, appeals, and dental home. In addition, attends virtual or in-person health fairs and community events, as directed by business need. 

How you will contribute: 

• Facilitate the delivery of preventive dental services for eligible members every six months beginning at six months of age.  

• Including engagement of members via telephone to support outreach business objectives. Facilitate the delivery of preventive dental services for new members within 90 days of enrollment. 

• Collaborate with other advocate specialists, Outreach Coordinators, and marketing department in the development of generic and customized outreach strategies for increasing dental access rates. 

• Coordinate with community engagement of health plan and clients via virtual or in-person opportunities. 

• Collect, compile and analyze information gleaned from virtual or in-person outreach initiatives/events in order to determine impact, and recommend changes that may make future outreach projects more effective. 

• Establish and maintain community relationships that provide for participation in health care initiatives and programs to create dental awareness. These relationships will aid in the member advocate’s ability to refer members to community resources that can accommodate members’ needs if the services are not medically necessary covered dental services. 

• Understand the cultural and socio-economic characteristics of their region(s).  

• Assist members, either in person or via telephone, with writing complaints.  

• Responsible for monitoring complaints through completion. 

• Collaborate with customer service staff to ensure members are contacted for dental appointments to be scheduled in a timely manner (within 30 days for routine care/within 28 days for routine care in NY). 

• Establish and maintain a process to manage dental care and continuity of care for individuals with special health needs. 

• Facilitate and support the dental home process in their region.  

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