Clinical Review Support Specialist, 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: 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 Clinical Review Specialist provides timely and accurate review and authorization of dental services based on eligibility and contract requirements. How you will contribute: • Successful completion of the Clinical Review Specialist training program • Read, interpret and evaluate x-rays, models and requests for major dental services based on medical necessity, client coverage, provider participation and member eligibility, in accordance with contract language • Resolve claim and prior authorization suspends that require UM Review • Consistently meet productivity requirements • Maintain audit score of 95% or greater • Pass the IRR quarterly • Communicate and work effectively with co-workers and Team Leads to coordinate workload to ensure all work is completed daily • Knowledge of reference materials and documentation that contain market nuances • Respond to follow-ups • Provide customer service via the telephone to providers regarding clinical issues • Other duties as assigned What you will bring with you: • High School Diploma or equivalent • 1 year dental assisting experience • Previous dental insurance experience a plus • Ability to read and interpret x-rays, dental models, photos, and/or patient charts • Good interpersonal skills • Ability to work without supervision • Excellent oral and written communication skills • Efficient PC skills (Word, Excel, Outlook) • Ability to prioritize and organize multiple tasks • Ability to remain organized with multiple interruptions • Knowledge of telephone systems • Ability to work in excess of 40 hours in a week • Required to attend additional training as required/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 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. Salary Range: $37,900 - 51,200 At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualification, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive awarded based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions. 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 [email protected] 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: Claims - Health & Dental Posting End Date: 24/03/2025 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 Apply Job!