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Customer Service
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.
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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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| 📍 | 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. |
Back to Remote jobs >
Customer Service
Customer Service
|
Salary
💸
$39,700 - $63,500 annually based on location
|
Remote
Location
USA
|
|
Job Type
full-time
|
Posted
Mar 15, 2025
|
️
| 📍 | 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. |
