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Sun Life Financial (U.S.) Services Company, Inc.
Wellesley Hills, United States (remote)
10 days ago
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1 - 25 Results of 295
Sun Life Financial (U.S.) Services Company, Inc.
Wellesley Hills, United States
(remote)
10 days ago
Job Type
Full-Time
Job Function
Other

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 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:

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:

Strategically lead and direct activities in Dental Claim and Vision Operations to achieve superior operational and financial performance.  Ensure departments meets or exceeds member, provider, and client expectations and is consistent with corporate goals and standards.  Drives  process excellence in claim and vision operations through an integrated process of operational, systems, quality, and resource management. 

How you will contribute:

  • SLAs: Establish and maintain operational protocols, meaningful goals and metrics for all pertinent functions to meet service level agreements, internal standards, and external expectations.

  • SLAs: Ensure Executives receive the appropriate updates and notification of potential business risks by providing and maintaining standardized reporting of metrics, statistics, accomplishments, priorities and issues.

  • Escalations: Develops systems to support escalated disputes and may address escalated issues as needed.  Make financial decisions around adjustments and exceptions that meet business, provider, client, and auditing requirements.

  • Ops MGT: Responsible for the end to end dental claim payment functions, including but not limited to: claim payment process, claim payment data, claim payment solutions, cross departmental management, claim correspondence, retention, and research of payment files.  Responsible for end to end vision operations functions to include, claim operations, utilization management, network development, network management, compliance, and client audits.  

  • Ops Mgt: Lead the development of operational systems that allow for analysis of trends, set thresholds, and proactively identify problems.  Troubleshoot operational system issues and develop solutions.

  • Ops Mgt: Demonstrate command over top line performance metrics

  • Ops Mgt: Build strong, collaborative working relationships with other functional areas across the Enterprise to ensure all processes and work interdependencies are identified and addressed on an ongoing basis. 

  • Ops Mgt: Responsible to ensure proper utilization of labor and overtime to achieve the service levels agreements within budget.

  • Clients: Meet with clients and represent all of operations within sales, implementation, and maintenance phases of relationship.  Conduct client presentations of system, processes, that highlight operational capabilities for vision and dental managed care programs..

  • Clients: Influence various constituencies, including clients, on strategic change to business processes.

  • Innovation: Translate existing business needs into future process redesign and/or technology solutions.

  • Innovation: Identify enhancements to current system platform to gain efficiencies and ensure enhancements are delivered on timely and on budget.

  • Innovation: Drive strategic initiatives such as automation and self service

  • Innovation: Lead the process and/or technical improvements to reduce defects and improve system efficiency and human productivity

  • Financial: Collaborate with finance, dental management, and UM to understand and positively influence loss ratios and access to care while also managing operational and labor expenses within claim and vision operations.

  • Financial: Develop and manage budget, meeting financial targets and efficiency goals annually.  Maintain strong understanding of labor and operational expenses.

  • Growth: Partner with the SMEs throughout the planning, analysis, design, testing and deployment phases to facilitate business requirements definition, business priorities, solution identification, and solution development lifecycle.  Operate as SME in appropriate instances.

  • Growth: Provide input and approval for all system changes.

  • Growth: Influence new membership growth and existing membership retention through effective management  

  • Strategy and Goals: Capture the tactical and strategic business goals that provide traceability through the organization, ensure they cascade through to individual contributors.

  • Strategy and Goals: Participate effectively as an integral member of the leadership team to prioritize corporate initiatives, and manage company-wide expectations through effective project process, monitoring, and communication. 

  • Staff Mgt: Complete all employee management duties, including but not limited to: hiring, training, terminations, corrective active plans, reward and recognition, preparation and presentation of performance evaluations assuring compliance with DentaQuest's policies creating an environment of performance and operational excellence.

  • Staff Mgt: Influence staffs to achieve organization & corporate objectives while helping employees understand current and new business directions.

  • Staff Mgt: Anticipate resource needs, establish appropriate priorities and eliminate unnecessary functions. 

  • Tech Acumen: Establish and maintain functional and technical knowledge of Windward and enabling technologies to be able to respond to unique requests made by clients; work collaboratively with clients to meet their needs without compromising DQ principles.

  • Tech Acumen: Ability to be business lead in understanding systems requirements and functionality.

  • Policy: Ensure regulatory and legal compliance within department.

  • Policy: Directs  strategic workflow and policy for dental claim and vision operations.

  • Recognize and promote diversity in all aspects of resource management.

  • Effectively perform Leadership functions for varied corporate initiatives.

  • Other duties as assigned.

What you will bring with you:

Required:

  • Bachelor Degree with 10 years claim processing/healthcare experience

  • Demonstrated ability to manage large teams, implement process improvements, meet financial expectations, and develop teams.

Preferred:

  • Excellent strategic thinking and problem-solving abilities, with the capability to analyze complex operational issues and implement effective solutions.

  • Exceptional communication and interpersonal skills, with the ability to collaborate and build relationships with diverse stakeholders.

  • Strong business acumen and financial literacy, with the ability to analyze financial data and make data-driven decisions.

  • Proficient in project management methodologies, with the ability to prioritize and manage multiple projects and initiatives concurrently.

  • Deep understanding of operational processes and best practices across multiple functional areas, including production, supply chain, logistics, and customer service.

  • Strong negotiation and contract management skills, with the ability to build and maintain partnerships with external parties.

  • Proficient in using data and analytics to drive operational improvements and optimize performance.

  • Solid knowledge of relevant regulatory requirements and compliance standards.

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.

Salary range: $172,200 - $258,300

    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 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.

    #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 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.

    For applicants residing in California, please read our employee California Privacy Policy and Notice.

    Job Category:

    Claims - Health & Dental

    Posting End Date:

    29/02/2024

    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



    Job ID: 72189588
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