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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 welcome applicants from anywhere in the U.S.
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 Utilization Management Support Coordinator provides various critical components necessary to day-to-day operational functions while ensuring proper workflow between the Utilization Management Department, providers and internal departments. This role coordinates Continuation of Care orthodontic benefits.
How you will contribute:
- Determine dollar amount, calculate financial responsibility, and enter Orthodontic Continuation of Care cases based on prior claims submitted, submitted explanation of benefits, treatment plan and other supporting documentation.
- Review, research and respond to inquiries routed via telephone, follow-ups, and email.
- Investigate and manage orthodontic reimbursement inquiries with Client/Provider Engagement, Claims, and Customer Service departments.
- Verbally communicate authorization decisions to providers, request additional information when necessary, and appropriately document the phone call in the system.
- Coordinate, manage and distribute incoming faxes to facilitate distribution to appropriate parties within the organization.
- Assemble Ortho CAD (electronic orthodontic requests) submission forms in preparation for review.
- Prepare and coordinate general anesthesia/IV requests
- Organize, coordinate, and communicate Outpatient Facility Requests to appropriate State and/or Managed Care Organizations.
- Process requests received in the Outpatient Facility Specialist queue.
- Communicate to management ways to improve processes and productivity of company.
- Assist with administrative and other duties as assigned.
What you will bring with you:
- High School Diploma or equivalent.
- 1 year experience in clerical setting
- Knowledge of general computer software.
- Knowledge of telephone systems.
- Knowledge of dental terminology.
- Typing skills of 30+ wpm.
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 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: $35,000 - 41,200 annually
- Central region: $36,900 - 43,400 annually
- Northern region: $41,300 - 55,800 annually
If you are a Colorado resident, the salary range for this position is $33,400 - 39,300 annually.
If you are a New York resident, the salary range for this position is $41,300 - 55,800 annually.
If you are Washington resident, the salary range for this position is $36,900 - 43,400 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.
Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email recruitingUS@sunlife.com to request an accommodation.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
Job Category:
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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
