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 welcome applicants from anywhere in the U.S.

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 Member Enrollment Associate handles all processes related to membership, including eligibility EDI (EE), online enrollment (OE), and manual requests, and ensures membership accuracy within the system. Works collaboratively with external clients on their EE and OE submissions to provide education and ensure standards are met. Researches and resolves membership issues through professional interaction with appropriate external client contacts and other internal stakeholders. Handles clients’ membership implementations, from onset to implementation, and maintains consistent communication to stakeholders.

How you will contribute:

• Document client-specific eligibility business rules using tools such as Word, Visio and Excel; communicate business rules to IT.
• Understand and utilize the IT applications and tools used to support data mapping, business rules, and HIPAA compliance; work with IT to implement technical aspects of system and data configurations based on business rules.
• Manage new eligibility EDI (EE) implementations and changes to existing clients’ EE files through conference calls, e-mails, on-site visits, and ongoing customer communication.
• Maintain HIPAA 834 and Proprietary Companion Guides that enables clients to comply with processing requirements and reduce errors.
• Manage a high volume of tasks with competing priorities.
• Partner with IT to diagnose, perform user acceptance test (UAT), and approve code fixes into production.
• Provide superior customer service by responding to client membership-related inquiries in a timely and accurate manner; may require extensive research with diverse resources.
• Establish and maintain membership data via EE files; manage timely and accurate processing of files to ensure all systems have correct data.
• Analyze incoming EE files to confirm file format requirements are met; educate customers.
• Support Online Enrollment application by working directly with clients on setup, maintenance and problem solving; handle OE phone calls.
• Provide superior customer service by handling the membership/eligibility phone line; address callers’ needs timely and accurately.
• Identify EDI solutions to business needs and constantly improve the effectiveness of our communications as they relate to eligibility and membership.
• Proactively communicate and coordinate eligibility issues with Sales, Client Services, Customer Service and impacted departments; work collaboratively with these departments to develop solutions.
• Accurately establish and maintain membership data for new and existing members through paper/manual process in accordance with processing guidelines and standards; meet department SLA’s for turnaround times and quaility.
• Support company goals by participating on and providing membership expertise to departmental and company projects.
• Assist clients in the interpretation and management of membership and eligibility reports.
• Other duties as needed or required.

What you will bring with you:

• Associate’s Degree plus 2 years related EDI or Business Analyst experience.
• Possess strong analytical and creative problem solving skills.
• Excellent verbal and written communication skills.
• Excellent organizational and time management skills.
• Ability to analyze and interpret EDI files Ability to work independently without close supervision.
• Demonstrates self-motivation by taking initiative to learn more and take on more challenges.
• Use decision making skills to prioritize effectively.
• Embrace change; positively influence change.
• Microsoft Office (Word, Excel).
• Understanding of SSIS and ‘source to target’ data mapping.
• Specific knowledge of enrollment processes in a commercial, Medicaid, or Medicare Health Plan/TPA organization.
• Working knowledge of FTP.

Preferred:

• Bachelor’s degree preferred
• Knowledge of HIPAA 834 transaction a plus.

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: $45,700 - $61,600 annually
• Central region: $48,100 - $65,000 annually
• Northern region: $51,500 - $69,400 annually

If you are a Colorado resident, the salary range for this position is $43,600 - $58,800 annually.

If you are a New York resident, the salary range for this position is $51,500 - $69,400 annually.

If you are Washington resident, the salary range for this position is $48,100 - $65,000 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 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.

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.

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