Dental Claims Consultant

at  Sun Life

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.

NOTES/UNIQUE REQUIREMENTS:

• Overtime may be required as dictated by business need
• This role requires a set production and quality target range to be met daily
• Good knowledge of the special policies.

HYBRID ROLE

The claims consultant will support the day to day accurate and timely handling of claims.
This includes managing escalated client issues, subrogation and claims involving legal case management, ombudsmen claims and client impact situations. Assisting and monitoring questions from analysts/seniors to promote accurate and timely adjudication of claims and directing further investigations where necessary. Serve as the Claims Representative and key participant for install meetings, client requested tours and demonstrations, training roll outs and change initiatives.
Also defined are competency levels for Teamwork, Customer Service, Giving and Receiving Feedback and Problem-solving and Decision-making.

WHAT WILL YOU DO:

• Understand systems, processes and other GB departments (Client Services, Group IT, etc.);
• Process and resolve escalated claims issues with Plan Sponsors, Plan Members, Business Development (Account Executives, Service Representatives), GBCCC and Member Impact Team(MIT). Understand systems, processes and other GB departments (Client Services, Group IT, etc.);
• Field and manage questions from the analysts/seniors
• Attend pre-install meetings and provide input from a claims adjudication perspective
• Investigate and resolve Ombudsman’s cases, includes contacts with ombudsman’s office and client (both verbal and written communication required);
• Successfully support claims team through change initiatives
• Lead and manage on-going training roll-outs
• Participate in client tours and claims demonstrations
• Serve as claims representative for Best Practice
• Run focus reports and contribute to management of results to ensure service standards are met
• Participate in departmental or GB projects as required
• Maintain confidentiality and clean desk policy at all times;
• Understand and adhere to Sun Life Financial Code of Business Conduct;
• Participate in the establishment of individual performance plans;
• Attend training as required;
• Contribute to the overall success of ACT; keep Customer satisfaction (our direct influence on the Customer Loyalty Index and Member Loyalty Index) in mind and remain conscious of our departmental commitments;
• Support on-going changes within the department and across business units.

What do you need to succeed:

• Excellent communication (verbal and written) and interpersonal skills
• Excellent time management and organizational skills, ability to prioritize work and multi-task in order to meet complex claims service standards;
• Strong analytical, problem-solving and decision-making skills;
• Service oriented and customer focused;
• Knowledge and experience utilizing Microsoft Office (including MS Word and Excel) and Outlook;
• Strong knowledge of Group Health and Dental insurance products and services and processes (including business development and plan implementation);
• Strong knowledge of Health and Dental benefits and training;
• Strong Knowledge of Group Health and Dental insurance processes and terminology;
• Strong knowledge of the various reimbursement systems (Chess, Electronic Data Interchange, Pay Direct Claims, Apollo);
• Strong knowledge of Web process;
• Basic mathematical skills;
• Solid Team contributor and role model;
• Ability to work with a positive attitude.
• Ability to navigate in Athena
• Ability to identify and bring forward potential training needs for Claims Analysts
• Ability to work both independently as well as part of a team;
• Ability to work with Organizational Effectiveness (OE) Training in order to identify and resolve inconsistencies in processes;
• Ability to continuously seek to improve process and participate on GB projects;
• Ability to manage tasks in a high-pressure production environment.
• As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only for the frequent interactions with English and French-speaking colleagues or internal partners across Canada or worldwide.