Sr. Claim Processing Representative, DentaQuest

Sun Life•Kansas City, MO

4d•Hybrid

About The Position

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. 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: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week. The opportunity: The Sr. Claim Processing Representative may specialize in one or more business units and are responsible for consistently processing advanced and complex claims with 99% or greater accuracy using proprietary claim processing software.

Requirements

Associates degree and/or four years of experience in a business environment
Strong math skills
Previous claim processing experience required
Attention to detail, accuracy and organization skills are essential
Understanding of general insurance guidelines
Ability to efficiently operate computer
Strong interpersonal, written and verbal communication skills
Self-motivation demonstrated by taking initiative to learn more and assume new challenges
Cooperative, professional and effective interaction skills with co-workers, business partners and visitors
Ability to work in excess of 40 hours in one week
Ability to use Microsoft Office (Word, Excel and Outlook)
Able to follow verbal and written instructions
Ability to communicate in an active environment
Ability to communicate via telephone or computer technology, via written and verbal channels

Responsibilities

Consistently process advanced & complex claim queues with a 99% or greater accuracy rate.
Uses business knowledge to resolve advanced claim processing scenarios including, but not limited to, COB (coordination of benefits), ORTHO (orthodontia) cases, TPL (third party liability), and manual pricing.
Responsible for adjustments to complex claims, as necessary, to meet corporate goals.
Process Direct Member Reimbursement claims, to include calling providers and members for missing information.
Serve as back up to Claim administration team by processing adjustments, posting check refunds and completing follow ups
Serve as back up to Claim Research and Resolution team by researching and resolving claim issues
May serve as back up to Team Lead in daily reporting
Successful completion of more complex projects, as assigned
Perform other duties as requested

Benefits

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.
Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.
Enjoy a flexible, inclusive and collaborative work environment that supports career growth.
We’re proud to be recognized in our communities as a top employer.
Proudly Great Place to Work® Certified in Canada and the U.S., we’ve also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.

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