Member Enrollment Analyst, DentaQuest

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.

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.

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 Member Enrollment Analyst (MEA) is a leader; accountable for the coordination implementation and training of all processes related to eligibility EDI 834. This role has a general knowledge of all clients electronic enrollment (EE) files to prioritize and coordinate the running of EE files. Handles high profile critical client implementations from onset to implementation and ensures membership accuracy within the system. The MEA will exhibit the highest level of knowledge of the EE process and membership data and assist in the reconciliation of the claims systems membership data to our financial system.

How you will contribute:

• Document client-specific eligibility business rules using tools such as Word Visio and Excel; communicate business rules to IT.
• Discern and utilize the IT applications and tools used to aid data mapping business rules and HIPAA compliance; work with IT to implement technical aspects of system and data configurations based on business rules.
• Manage new eligibility EDI electronic enrollment (EE) implementations and changes to existing clients EE files through conference calls e-mails on-site visits and ongoing customer communication.
• Author and maintain HIPAA 834 and Proprietary Companion Guides that enables clients to comply with processing requirements and reduce errors.
• Manage a high volume of projects and tasks with different priorities.
• Facilitate team meetings to share information related to membership and EE; ensure issues are communicated and understood by the team.
• Develop and maintain comprehensive schedules related to the status of new EE business; communicate regular statuses to Client Engagement Sales and other impacted departments.
• Perform monthly membership data reconciliation utilizing the HIPAA 834 EDI files; work closely with Client Engagement to review and communicate results.
• Partner with IT to implement new requirements; define requirements approve Use Cases perform user acceptance test (UAT) and approve code fixes into production.
• Prioritize EE files; work with supervisor to coordinate resources to accommodate the timely processing of files and meet or exceed service levels.
• Design develop and execute SQL queries to identify root cause where problems exist within membership data.
• Provide excellent customer service by responding to membership-related inquiries in a timely and accurate manner; may require extensive research with diverse resources.
• Establish and maintain membership data via EE files; manage timely and accurate processing of files to ensure all systems have correct data.
• Identify EDI solutions to business needs and constantly improve the effectiveness of our communications as they relate to eligibility and membership.
• Proactively communicate and coordinate eligibility issues with Sales Client Engagement and Customer Service and impacted departments; work collaboratively with these departments to develop solutions.
• Maintains company goals by participating on and providing eligibility EDI expertise to departmental and company projects.
• Assist clients in the interpretation and management of membership and eligibility reports.

What you will bring with you:

• Bachelors degree and related EDI or Business Analyst experience.
• Minimum 3 years of technical experience preferably with EDI.
• In depth knowledge of EDI Healthcare-related file formats including HIPAA 834 required.
• Deep functional understanding and hands-on experience implementing the 834 transaction.
• EDI source to target transaction mappings (834 and proprietary files).
• Spearhead and drive projects and teams successfully.
• Strong supervision and communication skills to drive compliance with eligibility EDI (EE) requirements among submitting constituents (i.e. clients).
• Unsupervised and strategic decision making.
• Excellent organizational and time management skills; ability to handle multiple projects and priorities.
• Demonstrates self-motivation by taking initiative to learn more and take on more duties.
• Embrace change; positively influence change.
• Working knowledge of SQL and database and system design; capable of writing and running SQL queries.
• Ability to work without others without close supervision.
• Microsoft Office (Word Excel PowerPoint Visio).
• Specific knowledge of enrollment processes in a commercial Medicaid or Medicare Health Plan/TPA organization.
• Working knowledge of FTP.
• Excellent reasoning skills
• EDI technical skills specifically using the 834 member enrollment transaction set preferred
• Excellent communication skills - both verbal and written
• Relationship building
• Excellent customer service skills
  

Salary: $69300 - 104000
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.