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Clinical Review Support Specialist @Sun Life Financial (U.S.) Services Company, Inc.

[Hiring] Clinical Review Support Specialist @Sun Life Financial (U.S.) Services Company, Inc.

Mar 15, 2025 - Sun Life Financial (U.S.) Services Company, Inc. is hiring a remote Clinical Review Support Specialist. 💸 Salary: $39,700 - $63,500 annually based on location. 📍Location: USA.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more.

Role Description

The Clinical Review Specialist provides timely and accurate review and authorization of dental services based on eligibility and contract requirements.

  • Successful completion of the Clinical Review Specialist training program
  • Read, interpret and evaluate x-rays, models and requests for major dental services based on medical necessity, client coverage, provider participation and member eligibility, in accordance with contract language
  • Resolve claim and prior authorization suspends that require UM Review
  • Consistently meet productivity requirements
  • Maintain audit score of 95% or greater
  • Pass the IRR quarterly
  • Communicate and work effectively with co-workers and Team Leads to coordinate workload to ensure all work is completed daily
  • Knowledge of reference materials and documentation that contain market nuances
  • Respond to follow-ups
  • Provide customer service via the telephone to providers regarding clinical issues
  • Other duties as assigned

Qualifications

  • High School Diploma or equivalent
  • 1 year dental assisting experience
  • Previous dental insurance experience a plus
  • Ability to read and interpret x-rays, dental models, photos, and/or patient charts
  • Good interpersonal skills
  • Ability to work without supervision
  • Excellent oral and written communication skills
  • Efficient PC skills (Word, Excel, Outlook)
  • Ability to prioritize and organize multiple tasks
  • Ability to remain organized with multiple interruptions
  • Knowledge of telephone systems
  • Ability to work in excess of 40 hours in a week
  • Required to attend additional training as required/deemed necessary

Benefits

  • Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial
  • 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
  • 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

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Before You Apply
📍 Be aware of the location restriction for this remote position: USA
Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more.
Clinical Review Support Specialist @Sun Life Financial (U.S.) Services Company, Inc.
Customer Service
Salary 💸 $39,700 - $63,500 annually based on location
Remote Location
USA
Job Type full-time
Posted Mar 15, 2025
Apply for this position Unlock 52,281 Remote Jobs
📍 Be aware of the location restriction for this remote position: USA
Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more.
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