Lead Claim Operations Representative, 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.

Location: We support US virtual 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 Lead Claim Operations Representative will guide the Claim Processing and/or Claim Administration team by daily workload allocation and queue management for assigned line(s) of business to ensure turnaround times are met while achieving exceptional operational performance and process excellence. Aid team success via technical training, coaching and guidance and development of efficient and effective processes, procedures and workflows.ows.

How you will contribute:

• Assist in providing training, coaching and feedback to team members on all aspects of claims processing and/or administration functions for assigned line(s) of business
• Monitor and oversee claim processor and/or claim administration daily work distribution and queue management on assigned line(s) of business to ensure turnaround time requirements are met
• Serve as subject matter expert on matters related to claim processing and/or claim administrator functions for assigned line(s) of business
• Develop and communicate processes, procedures and workflows to team members timely and accurately
• Complete internal claim handling audits to ensure compliance with workflows, processes and procedures
• Review and utilize QA audit results to provide personal and team level coaching and mentoring
• Identify and communicate adverse trends in claim handling behaviors; partner with Supervisor to ensure gaps and training needs are addressed
• Assist in ensuring staff meet or exceed Claims department productivity and quality metrics by providing one-on-one training and partnering with Supervisor to address claim processing concerns
• Assist with claim processing and administration scenarios including, but not limited to, refunds, corrections, follow ups, coordination of benefits, orthodontics, check returns, retention and all outstanding claim issues
• Collaborate with Supervisor in identifying and implementing process improvements that increase efficiency and accuracy
• Work with management to increase auto adjudication rates and self-service utilization
• Provide back up support to peer Team Leads

What you will bring with you:

• Associates degree
• Six years' experience in a business environment
• Strong math acumen
• Aptitude with computer software (Excel and MS Word) and technology
• Excellent interpersonal, written and verbal communication skills
• Proven ability to work well unsupervised and with a team
• Ability to prioritize and organize multiple tasks in the presence of ongoing interruptions
• Exceptional attention to detail and accuracy
• Self-motivated; takes initiative to learn and take on more tasks

Preferred:

• Claim processing experience in the dental field preferred
• Leadership, training and coaching experience is desirable

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.

If you are a California resident, the salary range for this position is:

• Southern region: 46,300 - 62,500 annually
• Central region: 48,800 - 65,900 annually
• Northern region: 52,200 - 70,400 annually

If you are a Colorado resident, the salary range for this position is 44,200 - 59,600 annually.

If you are a New York resident, the salary range for this position is 52,200 - 70,400 annually.

If you are Washington resident, the salary range for this position is 48,800 - 65,900 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.

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.