Sr. Claim Processing Representative, DentaQuest jobs in United States
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Sun Life · 8 hours ago

Sr. Claim Processing Representative, DentaQuest

Sun Life is one of the largest providers of employee and government benefits in the U.S., helping approximately 50 million Americans access essential care. They are seeking a Sr. Claim Processing Representative to specialize in processing advanced and complex claims with high accuracy, while also supporting other claim-related teams and projects.

FinanceFinancial ServicesInsurance
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Culture & Values
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H1B Sponsor Likelynote

Responsibilities

Consistently process advanced & complex claim queues with a 99% or greater accuracy rate
Uses business knowledge to resolve advanced claim processing scenarios including, but not limited to, COB (coordination of benefits), ORTHO (orthodontia) cases, TPL (third party liability), and manual pricing
Responsible for adjustments to complex claims, as necessary, to meet corporate goals
Process Direct Member Reimbursement claims, to include calling providers and members for missing information
Serve as back up to Claim administration team by processing adjustments, posting check refunds and completing follow ups
Serve as back up to Claim Research and Resolution team by researching and resolving claim issues
May serve as back up to Team Lead in daily reporting
Successful completion of more complex projects, as assigned
Perform other duties as requested

Qualification

Claim processing experienceMath skillsInsurance guidelinesMicrosoft Office proficiencyAttention to detailCooperative interaction skillsInterpersonal skillsWritten communication skillsVerbal communication skillsSelf-motivation

Required

Associates degree and/or four years of experience in a business environment
Strong math skills
Previous claim processing experience required
Attention to detail, accuracy and organization skills are essential
Understanding of general insurance guidelines
Ability to efficiently operate computer
Strong interpersonal, written and verbal communication skills
Self-motivation demonstrated by taking initiative to learn more and assume new challenges
Cooperative, professional and effective interaction skills with co-workers, business partners and visitors
Ability to work in excess of 40 hours in one week
Ability to use Microsoft Office (Word, Excel and Outlook)
Able to follow verbal and written instructions
Ability to communicate in an active environment
Ability to communicate via telephone or computer technology, via written and verbal channels

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

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Sun Life is a leading financial services organization dedicated to helping people achieve lifetime financial security and live healthier lives.

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 Company
Total Funding
$1.05B
2024-05-13Post Ipo Debt· $548.79M
2023-07-04Post Ipo Debt· $500M
2000-03-24IPO

Leadership Team

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Kevin Strain
President & CEO
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Luc Nhon Ly
Chief Executive Officer
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Company data provided by crunchbase