Sun Life · 1 month ago
Member Advocate Specialist, DentaQuest South TX ( Bilingual in Spanish)
U.S. Telecommuters
Full-time
Hybrid
Entry Level
$49K/yr - $66K/yr
3+ years expSun Life is one of the largest providers of employee and government benefits in the U.S., helping millions access essential care. The Member Advocate Specialist will oversee member advocacy related to preventive dental care and access, engage with members through outreach, and collaborate with community resources to improve dental awareness and services.
FinanceFinancial ServicesInsurance
Responsibilities
Facilitate the delivery of preventive dental services for eligible members every six months beginning at six months of age
Including engagement of members via telephone to support outreach business objectives. Facilitate the delivery of preventive dental services for new members within 90 days of enrollment
Collaborate with other advocate specialists, Outreach Coordinators, and marketing department in the development of generic and customized outreach strategies for increasing dental access rates
Coordinate with community engagement of health plan and clients via virtual or in-person opportunities
Collect, compile and analyze information gleaned from virtual or in-person outreach initiatives/events in order to determine impact, and recommend changes that may make future outreach projects more effective
Establish and maintain community relationships that provide for participation in health care initiatives and programs to create dental awareness. These relationships will aid in the member advocate’s ability to refer members to community resources that can accommodate members’ needs if the services are not medically necessary covered dental services
Understand the cultural and socio-economic characteristics of their region(s)
Assist members, either in person or via telephone, with writing complaints
Responsible for monitoring complaints through completion
Collaborate with customer service staff to ensure members are contacted for dental appointments to be scheduled in a timely manner (within 30 days for routine care/within 28 days for routine care in NY)
Establish and maintain a process to manage dental care and continuity of care for individuals with special health needs
Facilitate and support the dental home process in their region
This includes tasks such as assisting members with finding a dental home, coordinate case management for various populations including special needs and Children of Migrant Farm Workers (TX only), maintaining the data for reporting dental home activities, and coordinating outreach efforts
Submit tracking and trending reports related to dental home, member advocacy, migrant worker, care coordination and case management performance measures to DentaQuest management
Identify disparities, opportunities for improvement and recommended solutions
Help maintain and increase dental access requirements in compliance with dental home components, Medicaid, CHIP and Frew guidelines (for TX only)
Adhere to DentaQuest business processes
Collaborate with DentaQuest management, internal departments, state & local agencies and HHSC clients to plan, evaluate and implement activities to improve access and appropriate care to members
This includes making recommendations on changes that may improve either the care provided, or the way care is delivered
Ensure members receive educational materials upon enrollment regarding the services available through the Texas Health Steps program and how to obtain them
Educational material also includes information on:
Member’s rights and responsibilities
The complaint processes
The appeal processes
Medically necessary covered services available to them, including preventive services
Non-capitated services (benefits that are excluded from medically necessary services such as transportation)
Assist Children of Migrant Farm Workers receive prompt delivery of service, as they might transition into and out of the dental program more rapidly than the general population
This includes coordinating with their provider to make certain they receive preventive dental services prior to leaving Texas (“accelerated services”) if their routine checkup is scheduled after they leave Texas
Other duties as assigned
Qualification
Required
Bachelor's degree and/or 3 years of related experience in healthcare, advocacy or customer service
Fluent in Spanish, both written and spoken
Demonstrated proficiency in claims processing and issue resolution
Knowledge of clinical and industry terminology and procedures
Demonstrated commitment to health and wellness
Self-motivated, and ability to work with little supervision
Strong analytical skills
Strong problem-solving skills and the ability to make independent decisions
Strong written and oral communication skills
Knowledge of general computer software. (Outlook, Excel and MS Word)
Ability to communicate in an active office environment
Ability to travel throughout the State of Texas as needed
Valid Driver's License and Vehicle Insurance
Ability to efficiently operate all job-related office equipment
Ability to communicate via telephone and in writing
Ability to read and view computer screen
Preferred
Background in education or community advocacy
Enjoys meeting and talking to people
Bilingual language skills preferred
Experience working in a managed care environment is preferred
Creativity in promoting events and implementation of events is preferred
Knowledge of healthcare advocacy activities is preferred
Community Engagement Experience
Benefits
Generous vacation and sick time
Market-leading paid family, parental and adoption leave
Medical coverage
Company paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
401(k) employer match
Stock purchase options
Employer-funded retirement account
Flexible, inclusive and collaborative work environment that supports career growth
Company
Sun Life
Sun Life is a leading financial services organization dedicated to helping people achieve lifetime financial security and live healthier lives.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$1.05B2024-05-13Post Ipo Debt· $548.79M
2023-07-04Post Ipo Debt· $500M
2000-03-24IPO
Leadership Team
Kevin Strain
President & CEO
Luc Nhon Ly
Chief Executive Officer
Recent News
2025-12-02
MarketScreener
2025-12-02
South China Morning Post
2025-11-27
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