Appeals Specialist

SUN LIFE FINANCIAL • Milwaukee, WI • 3h ago

JOB REQUIREMENTS: 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: The
opportunity: The Appeal Specialist is responsible for the investigation
and resolution of all administrative and clinical appeals based upon
specific regulatory and or client requirements. In addition, this
position is responsible for the assembly and preparation of responses to
clients, members and/or providers. This position is responsible for
daily interaction with assigned market/client contacts, as well as
various internal departments. This position is also responsible to
ensure that all mandated turnaround times are met as well as required
processes and workflows are adhered to. How you will contribute:
Investigate, document and resolve member and provider appeals and
inquiries related to appeals in accordance with State and/or Plan
guidelines. Ensure all components of the appeal or request for
information are researched and addressed. Assemble necessary information
for the client so they may appropriately investigate an appeal when
DentaQuest is secondary. If contracted to do so, also investigate the
appeal and provide... For full info follow application link. Sun Life
Financial is an equal employment and affirmative action employer. All
qualified applicants will receive consideration without regard to race,
color, sex, religion, age, national origin, disability, veteran status,
sexual orientation, gender identity or expression, marital status,
ancestry or citizenship status, genetic information, pregnancy status or
any other characteristic protected by law. Sun Life Financial is
committed to building a diverse and inclusive company culture. 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 www.sunlife.com/us
to learn more. *** APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/EE89BEA4717745B7

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