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. Youll 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, youll 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 support US flexible working arrangements in the contiguous 48 states.

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 Research and Resolution Specialist role specializes in one or more business units and performs a high level of problem solving. The role must use judgment and prior experience to accurately research complex payment and processing scenarios and apply existing and new solutions to close claim and payment inquiries. Accuracy of 99% or higher is required.

How you will contribute:

Consistently research and resolve advanced & complex payment and adjustment scenarios with 99% or greater accuracy.
Work closely with providers, members and clients to properly resolve claim issues.
Communicate with provider offices and work with staff to resolve disputes over complex claim payment scenarios.
Exhibit strong knowledge of business protocols and recommend unique solutions to complex scenarios.
Understand and assist with payment processes to ensure accurate & timely payment of claims.
Uses business knowledge to resolve advanced claim adjustment scenarios including, but not limited to, refunds, corrections, follow ups, coordination of benefits, orthodontia and all outstanding claim issues.
May work with unsatisfied customers to resolve payment inquiries.
Provides adjustments to complex claims as necessary to meet corporate goals.
Document work product and track outstanding items and turnaround times within Windward or other manual tracking tools such as excel spreadsheets.
Collaborate with members of sales, client services and provider relations to address outstanding claim concerns.
Communicate with leadership on processing trends and assist in proactively resolving broader claim issues.
Research, evaluate, resolve and reply to any internal and external inquires.
Work with management to increase auto adjudication rates.
Process map workflow and manage resolution to ad hoc scenarios.
May serve as back up to call center during peak periods to achieve corporate wide service levels.
Serve as back up to Claim Administration team by adjusting claims, posting refund checks and/or processing follow ups.
Other duties as needed or required.

What you will bring with you:

High school diploma
Four years of experience in a business environment; experience working in the insurance industry a plus
Excellent math aptitude
Previous claim processing experience required
Exceptionally strong interpersonal, written and verbal communication skills
Attention to detail, accuracy and organization skills are essential
Understanding of general insurance principles
Independent and strategic decision making
Self-motivation demonstrated by taking initiative to learn more and assume more tasks
Cooperative, professional and effective interaction skills with co-workers, business partners and visitors
Experienced in Microsoft Office (Word, Excel and Outlook)
Effective use of office equipment including, but not limited to, computers and printers
Able to follow verbal and written instructions
Ability to read and comprehend at a post high school level
Ability to communicate in an dynamic office environment
Ability to use basic office equipment and communicate via phone, computer technology, and via written and verbal channels
Required to attend additional training as requested/deemed necessary.

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 (https://pages.beamery.com/sunlifecareers/page/join-us-canada) 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 Globes “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: $53,400 - 75,840 annually
Northern region: $53,400 - 75,840 annually

If you are a Colorado or Nevada resident, the salary range for this position is $46,300 - 68,580 annually.
If you are a Connecticut or Maryland resident, the salary range for this position is $50,600 - 71,840 annually
If you are Washington or Rhode Island resident, the salary range for this position is $53,400 - 75,840 annually
If you are a New York resident, the salary range for this position is $53,400 - 75,840 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.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

Job Category:

Claims - Health & Dental

Posting End Date:

02/01/2025