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Customer Service / Operations

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. Youll 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, youll 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.

Job Description

Must reside in Harris County, TX

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 Member Advocate Specialist (MAS) has direct oversight for the advocacy of members included but not limited to preventive dental care, access to care, education, complaints and grievances, appeals, and dental home. In addition, attends virtual or in-person health fairs and community events, as directed by business need.

How you will contribute

  • 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.
  • Other duties as assigned.

Member Advocate Specialist TX

  • 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.

What you will bring with you

  • Bachelor's degree and/or 3 years of related experience in healthcare, advocacy or customer service.
  • 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/State of New York as needed, including travel to other DentaQuest offices located in other states.
  • Ability to efficiently operate all job-related office
  • equipment.
  • Ability to communicate via telephone and in writing.
  • Ability to read and view computer screen.
  • The department is in a wheelchair accessible
  • building.
  • The office environment is active with high voice levels and interruptions that may challenge hearing and
  • concentration.

Preferred

  • Registered Dental
  • Hygienist
  • 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

PHYSICAL DEMANDS

  • Incumbent must be able to communicate effectively.
  • Requires overall light physical effort (up to 25lbs.)
  • Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal
  • compute).
  • Ability to travel or move about within and outside serviced facilities required.
  • Incumbent works primarily in either a private or shared office environment.

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

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 Globes 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.

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

www.sunlife.com/us

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.

#LI-remote

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

recruitingUS@sunlife.com

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.

For applicants residing in California, please read our employee

California Privacy Policy and Notice.

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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 vetera