Associate Operations Correspondence Analyst, 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:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week.

The opportunity:

The Associate Operations Correspondence Analyst is part of the Operations Correspondence Templates team, reporting to the Operations Correspondence Senior Manager. Implements and maintains the templates utilized for correspondence required based on operational activity and driven by requirements defined by federal/state regulation, NCQA and URAC.

How you will contribute:

• Manage efforts to implement and revise correspondence, resulting from operation activity for utilization management, claims, and complaints/grievance/appeals, to ensure accurate content within the templates and the templates are implemented or revised within the timelines required.

• Completion of the client requirement document (CRD) to accurately reflect contract and regulatory requirements.

• Presentation of the CRD content to the client. Coordinate revisions necessary to final completion and client approval.

• Identify the templates required for implementation, based on operational process and requirements. Draft a template document, as necessary.

• Ensure template content meets requirements based on client contract, regulations, NCQA and/or URAC.

• Perform gap analysis for correspondence requirements and system functionality and/or current process and develop strategic solutions to ensure compliance with requirements.

• Coordinate template implementation and revisions with the client, client services, operations, the correspondence technical team and the Operations Correspondence Senior Manager.

• Define the rules necessary to accurately populate variable information within the template. Communicate the rules effectively to the correspondence technical team.

• Mock up samples of the templates and submit to the correspondence technical team to draft production samples. Define the parameters to be utilized to produce the samples, when necessary. Review production samples provided to ensure accuracy.

• Obtain approval from the client of the production samples. Coordinate through client services, as necessary.

• Coordinate production of the template with the correspondence technical team after approval has been received.

• Coordinate with the Operations Correspondence Senior Manager to create cases to test triggers for templates for complaint/grievance/appeals.

• Obtain translation of template content into non-English language(s), as necessary.

• Audit production samples of the letter files once the template is put into production.

• Communicate all template implementation and revisions to the applicable operational department.

• Audit templates periodically to ensure most recent approved template is in production.

• Assist the Operations Correspondence Senior Manager to determine root cause for all findings identified in an external audit, relating to correspondence.

• Correct errors identified by the UM Administrative Coordinators relating to mapping to citations and member denial language.

• Create and maintain a letter library and tracking mechanism for all current and historical templates for each client. Documentation to include client approval and