Claim Administrator Associate (DentaQuest) remote

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.

The opportunity:

The Claims Administrator Associate may specialize in one or more business units and perform the highest level of processing. This role must use judgment and prior experience to accurately post refund checks, process complex follow ups that could not be resolved elsewhere and adjust claims to a final resolution. Accuracy of 99% or higher is required.

How you will contribute:

• Consistently process advanced & complex claim adjustments with a 99% or greater accuracy rate.
• Uses business knowledge to resolve advanced claim adjustment scenarios including, but not limited to, refunds, corrections, follow ups, coordination of benefits, orthodontia, check returns, retention and all outstanding claim issues.
• Makes 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.
• Work closely with providers, members and clients to properly resolve claim issues.
• Collaborate with members of sales, client services and provider relations to address outstanding claim issues.
• Communicate with leadership on claim trends to assist in proactively resolving broader claim issues.
• Work with management to increase auto adjudication rates and self-service utilization.
• Process map workflow and guide resolution of ad hoc scenarios.
• May serve as back up to call center during peak periods by taking provider and member calls to ensure corporate wide service levels are consistently achieved.
• Serve as back up to Claim Research and Resolution team by researching and resolving claim issues
• Other duties as needed or required.

What you will bring with you:

• Associates degree and/or Six years' experience in a business environment.
• Strong math skills.
• Previous claim processing experience required.
• Attention to detail, accuracy and organization skills are essential.
• Grasp of general insurance principles. Separate and strategic decision making.
• Strong interpersonal, written and verbal communication skills.
• Self-motivation demonstrated by taking initiative to learn more and assume on more tasks.
• Cooperative, professional and effective interaction skills with co-workers, business partners and visitors.
• Ability to work in excess of 40 hours in a week.
• Ability to efficiently operate computer.
• 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 a dynamic office environment.
• Ability to sit for more than 90% of an 8 hour day.
• Ability to use basic office equipment and communicate via telephone or computer technology, by way of written and verbal channels.
• Required to attend additional training as requested/deemed necessary.

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.

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