Vision Claims - Wellesley Hills, United States - DentaQuest

DentaQuest

Verified Company

Wellesley Hills, United States

2 days ago

Posted by:

Mark Lane

beBee recruiter

Description

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 outcomesbased, costeffective 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 our Clients.

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 challenged by working with dynamic colleagues to 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.
Wellorganized 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 mínimal supervision.
Ability to prioritize and organize multiple tasks with tight deadlines.
Attend additional training as requested/deemed necessary.
Excellent customer service skills.

Life is brighter when you work at Sun Life

Excellent benefits and wellness programs to support the three pillars of your wellbeing mental, physical and financial including generous vacation and sick time, marketleading paid family, parental and adoption leave, a partiallypaid 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 employerpaid match as well as an employerfunded 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: