Clinical Review Specialist, DentaQuest
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Job Location:
Milwaukee, WI - USA
Monthly Salary:
$ 38200 - 51600
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
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 6400 employees and associates in our partner dental practices and operate nationwide.
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 Clinical Review Specialist provides timely and accurate review and authorization of dental services based on eligibility and contract requirements.
How you will contribute:
Successful completion of the Clinical Review Specialist training program
Read interpret and evaluate x-rays models and requests for major dental services based on medical necessity client coverage provider participation and member eligibility in accordance with contract language
Resolve claim and prior authorization suspends that require UM Review
Consistently meet productivity requirements
Maintain audit score of 95% or greater
Pass the IRR quarterly
Communicate and work effectively with co-workers and Team Leads to coordinate workload to ensure all work is completed daily
Knowledge of reference materials and documentation that contain market nuances
Respond to follow-ups
Provide customer service via the telephone to providers regarding clinical issues
Other duties as assigned
What you will bring with you:
High School Diploma or equivalent
1 year dental assisting experience
Previous dental insurance experience a plus
Ability to read and interpret x-rays dental models photos and/or patient charts
Good interpersonal skills
Ability to work without supervision
Excellent oral and written communication skills
Efficient PC skills (Word Excel Outlook)
Ability to prioritize and organize multiple tasks
Ability to remain organized with multiple interruptions
Knowledge of telephone systems
Ability to work in excess of 40 hours in a week
Required to attend additional training as required/deemed necessary
Salary: $38200 - 51600
At our company we are committed to pay transparency and equity. The salary range for this role is competitive nationwide and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills qualifications experience education and geographic addition to your base salary this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.
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We are committed to fostering an inclusive environment where all employees feel they belong are supported and empowered to thrive. We are dedicated to building teams with varied experiences backgrounds perspectives and ideas that benefit our colleagues clients and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.
Life is brighter when you work at Sun Life
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. Were proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S. weve also been recognized as a Top 10 employer by the Boston Globes Top Places to Work for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.
We will make reasonable accommodations to the known physical or mental limitations 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.
For applicants residing in California please read our employee California Privacy Policy and Notice.
We do not require or administer lie detector tests as a condition of employment or continued employment.
Sun Life will consider for employment all qualified applicants including those with criminal histories in a manner consistent with the requirements of applicable state and local laws including applicable fair chance ordinances.
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.
Job Category:
Posting End Date:
Required Experience:
IC
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
We offer trusted insurance products and investment solutions to Canadian residents and organizations. Get secure access to your employee benefits, health claims and group savings plans. Or, connect with a Sun Life advisor to get life or health insurance, set up a savings plan, open an ... View more
