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Form of workDentaQuest 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 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 Claims Administrator Associate may specialize in one or more business units and perform the highest level of processing. This role must use independent 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 independently 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 lead 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.
- Associates degree and/or Six years' experience in a business environment.
- Strong math competency.
- Previous claim processing experience required.
- Attention to detail, accuracy and organization skills are essential.
- Understanding of general insurance principles. Independent and strategic decision making.
- Strong interpersonal, written and verbal communication skills.
- Self-motivation demonstrated by taking initiative to learn more and assume on more challenges.
- 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 an active 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.
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
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 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 48,8090 - 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 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 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
Job Category: Claims - Health & Dental
Posting End Date:
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
