Sr. Claim Processing Representative, 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: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work.

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. 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 challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.

The opportunity:

The Sr. Claim Processing Representative may specialize in one or more business units and is 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, including calling providers and members for missing information.
• Serve as backup to Claim administration team by processing adjustments, posting check refunds and completing follow-ups
• Serve as backup to Claim Research and Resolution team by researching and resolving claim issues
• May serve as backup 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 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 read and comprehend at a high school level
• Ability to communicate in an active environment
• Ability to sit for more than 90% of an 8 hour day
• Ability to communicate via telephone or computer technology, via written and verbal channels

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 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