Associate Operations Correspondence Analyst - DentaQuest

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

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: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our leaders are expected to foster connection and teamwork by being present in the office 2 to 3 days per week.

The opportunity:

The Associate Operations Correspondence Analyst is part of the Operations Correspondence Templates team, reporting to the Operations Correspondence Senior Manager. Implements and maintains the templates utilized for correspondence required based on operational activity and driven by requirements defined by federal/state regulation, NCQA and URAC.

How you will contribute:

• Manage efforts to implement and revise correspondence, resulting from operation activity for utilization management, claims, and complaints/grievance/appeals, to ensure accurate content within the templates and the templates are implemented or revised within the timelines required.
• Completion of the client requirement document (CRD) to accurately reflect contract and regulatory requirements.
• Presentation of the CRD content to the client. Coordinate revisions necessary to final completion and client approval.
• Identify the templates required for implementation, based on operational process and requirements. Draft a template document, as necessary.
• Ensure template content meets requirements based on client contract, regulations, NCQA and/or URAC.
• Perform gap analysis for correspondence requirements and system functionality and/or current process and develop strategic solutions to ensure compliance with requirements.
• Coordinate template implementation and revisions with the client, client services, operations, the correspondence technical team and the Operations Correspondence Senior Manager.
• Define the rules necessary to accurately populate variable information within the template. Communicate the rules effectively to the correspondence technical team.
• Mock up samples of the templates and submit to the correspondence technical team to draft production samples. Define the parameters to be utilized to produce the samples, when necessary. Review production samples provided to ensure accuracy.
• Obtain approval from the client of the production samples. Coordinate through client services, as necessary.
• Coordinate production of the template with the correspondence technical team after approval has been received.
• Coordinate with the Operations Correspondence Senior Manager to create cases to test triggers for templates for complaint/grievance/appeals.
• Obtain translation of template content into non-English language(s), as necessary.
• Audit production samples of the letter files once the template is put into production.
• Communicate all template implementation and revisions to the applicable operational department.
• Audit templates periodically to ensure most recent approved template is in production.
• Assist the Operations Correspondence Senior Manager to determine root cause for all findings identified in an external audit, relating to correspondence.
• Correct errors identified by the UM Administrative Coordinators relating to mapping to citations and member denial language.
• Create and maintain a letter library and tracking mechanism for all current and historical templates for each client. Documentation to include client approval and the version of the template that is approved.
• Complete the process for Notice of Action (NOA) letters that require modification prior to mailing to the member to ensure modifications completed are accurate and completed timely.
• Cultivate and maintain professional relationships with both internal and external customers; communicate effectively with both internal and external customers using various methods of communication, including email, conference call, and video conferencing.
• Demonstrate a detailed understanding of requirements for correspondence for operations, as listed in individual client contracts and in federal and/or state regulations.
• Demonstrate a detailed understanding of DentaQuest policies and processes for correspondence for operations.
• Participate in market meetings to understand client requirements and changes. Communicate any items that impacts correspondence.
• Other duties as needed or required.

What you will bring with you:

Required:

• Associate degree in business, healthcare or related field (or equivalent work experience)
• Proficient with general computer software including Microsoft Excel, Word and Outlook.
• Exceptional communication skills and the ability to communicate appropriately at all levels of the organization. This to also include the ability to communicate appropriately with external customers, including clients and/or regulatory agencies.
• Excellent spirit for teamwork, problem-solving, communication, and decision-making skills.
• Strong situational analysis and decision-making abilities.
• Excellent verbal, written, interpersonal, organizational and public speaking/communication skills. Able to effectively communicate visualizations.
• Ability to prioritize and organize multiple tasks with tight deadlines.
• Ability to manage multiple projects and priorities in a fast-paced, result-driven environment.
• Excellent independent problem-solving skills.
• Self-motivated and has the ability to work with little supervision and make independent decisions.
• Demonstrated track record of attention to detail.
• Required to attend additional training as requested/deemed necessary.

Preferred:

• Minimum 3 years demonstrated experience managing multiple complex tasks with varying deadlines and competing priorities.
• Ability to work closely with internal business partners to ensure project completion.
• Previous experience managing template documents.
• Previous experience in professional or academic research
• Demonstrated experience managing relationships with internal/external customers and working closely with the external customer to implement processes.

Salary: $54,000 - 72,900

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualification, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations 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 thebrightside@sunlife.comto request an accommodation.

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

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

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.