Sun Life · 3 weeks ago
Member Enrollment Analyst, DentaQuest
Kansas City, Missouri
Full-time
Hybrid
Mid Level
$69K/yr - $104K/yr
3+ years expSun 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. The Member Enrollment Analyst is responsible for coordinating and implementing processes related to eligibility EDI 834, ensuring membership accuracy, and managing critical client implementations.
FinanceFinancial ServicesInsurance
Responsibilities
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
Qualification
Required
Bachelor's 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
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
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
H1B Sponsorship
Sun Life has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (22)
2024 (27)
2023 (18)
2022 (18)
2021 (12)
2020 (13)
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
Company data provided by crunchbase