Operations Documentation Representative, 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.

Location: This role reports to the Milwaukee office

At Sun Life, we look for optimistic people who want to make life brighter for ourClients.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 challengedbyworking withdynamic colleaguesto find new and innovative ways to make Sun Life the best benefits company in America.

The opportunity:

The Operations Documentation Representative identifies changes to State and/or Federal regulations, MCO contracts or NCQA requirements that may affect content of letters generated from Utilization Management and Complaints and Grievances activity.

How you will contribute:

• Participate in Market Meetings to discern client requirements and communicate any items that impacts determination or appeal letters.
• Perform quality audits daily on determination letters.
• Communicate any potential errors identified in auditing determination letters to the identified contact person(s) for the area that generates the document.
• Identify non-compliant determination letters and communicate to Operations Management. Work with UM to have denials overturned if required by State/Plan if letters are non-compliant.
• Coordinate with UM and C&G to submit determination letters for audits in the required timeframe
• Coordinate with Correspondence System team to correct any process issues that may cause errors with determination letters identified during the daily audit.
• Maintain documentation and track/trend errors identified during daily audit process.
• Batch and print member determination letters and prepare for mailing.
• Identify additional process improvements for determination letter process.
• Assist Supervisor with requests from health plans for determination letter information.
• Provide assistance to other departments with determination letter requests.
• Research and coordinate file requests for client audits.
• Perform duties of Operations Document Specialist I, as necessary.
• Perform clinical peer reviews.
• Other duties as assigned.

What you will bring with you:

• High School Diploma or equivalent.
• 2 years' experience in clerical setting.
• Ability to prioritize and organize multiple tasks.
• Ability to work unsupervised.
• Good PC Skills.
• Good Analytical ability.
• Strong attention to detail.
• Typing skills of 30 wpm.
• Excellent verbal and written communication skills.
• Ability to remain organized with multiple interruptions.
• Good knowledge of Word and Adobe PDF Writer programs.
• Knowledge of general computer software.
• Knowledge of telephone systems.
• Reports to and works under the supervision of the Correspondence Supervisor.
• Interacts in a cooperative, professional and effective manner with Provider offices, Health Plans, members, co-workers and company staff.
• 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 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.

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 thebrightside@sunlife.comto 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.