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.

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.

Location: We support US flexible working arrangements in the contiguous 48 states.

At Sun Life, we look for optimistic people who want to make life brighter for ourClients.We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work.Every day,you'll be empowered and challengedbyworking withdynamic colleaguesto find new and innovative ways to make Sun Life the best benefits company in America.

The opportunity:

The Vision Claims & Operations Representative is accountable for ensuring that claim payment and prior-authorization processing requirements for all our programs are contractually met as required. This role tracks trends of claims reprocessing to maximize cost savings.

How you will contribute:

• Adjudicate claims accurately in a timely manner per contractual and regulatory requirements.
• Resolve prior authorization requests accurately per program requirements.
• Process all requests for adjustments received internally and externally.
• Work with providers to gather missing information for claims and prior authorizations; resolve escalated claims.
• Resolve claims and prior authorizations related to tickets received from customer service calls and portal.
• Create and deliver client specific invoices for billing.
• Validate member eligibility is updated in a timely manner and work with the Client Data Management; systems vendors to address issues.
• Send accurate and timely prior authorization correspondence to members and providers.
• Report system issues to system vendor partners and collaborate on resolution.
• Use solid judgement to accurately adjudicate claims.
• Coordinate with Clinical Director to retroactively have claims reviewed.
• Track and evaluate trends for claim reprocessing projects.
• Back up for Vision Claims & Operations Associate I & III when needed.
• Other duties as needed or required.

What you will bring with you:

• High School diploma or Equivalent.
• Vision terminology knowledge and/or group health insurance experience.
• 2 years' experience within the healthcare or customer service field.
• Well-organized and exceptional organizational, written and oral communication skills.
• Ability to work well alone and as part of Team.
• Proficient with general computer software including Microsoft Excel, Word, and Outlook.
• Problem solving skills.
• Ability to make judgment conclusions based on data available with minimal supervision.
• Ability to prioritize and organize multiple tasks with tight deadlines.
• Attend additional training as requested/deemed necessary.
• Excellent customer service skills.

Do you see yourself in this role even if you haven't checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.

Not ready to apply yet but want to stay in touch? Join our talent community () to stay connected until the time is right for you!

Life is brighter when you work at Sun Life

• Excellent benefits and wellness programs to support the three pillars of your well-being - mental, physical and financial - including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account
• A flexible work environment with a friendly, caring, collaborative and inclusive culture
• Great Place to Work Certified in Canada and the U.S.
• Named as a "Top 10" employer by the Boston Globe's "Top Places to Work" two years running

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

If you are a California resident, the salary range for this position is:

• Southern region: $43,900 - 59,300 annually
• Central region: $41,700 - 56,300 annually
• Northern region: $47,000 - 63,500 annually

If you are a Colorado resident, the salary range for this position is $39,700 - 53,600 annually.
If you are a New York resident, the salary range for this position is $47,000 - 63,500 annually.
If you are Washington resident, the salary range for this position is $41,700 - 56,300 annually.

We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.

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 to learn more.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran