Dental Claim Specialist || Immediate Joiner

Role & responsibilities

Shift timings (01:30 PM - 10 PM )

Hybrid Mode- Work from office.

Looking for Immediate joiner.

What will you do?

• Review complex claims and estimates for completeness and follow processes for incomplete information on claims
• Assess and adjudicate complex claims and estimates
• Assessing includes studying dental information and plan provisions, researching, documenting results and communicating verbally and or in writing with the client (member/sponsor) to obtain additional details in order to make an informed decision
• Meet production and quality standards set for individuals, teams and department (timeliness, quality and service)
• Handle external and internal inquiries via written correspondence, e-mails and telephone as required
• Participate in departmental projects as required.
• Work in conjunction with the Dental Consultant on contentious cases, and with other departments/offices within the company in order to meet customer expectations

Key Qualifications and experience:

• Diploma in Dental Hygiene (CEGEP/College or University
• Experience working in a dental clinic
• Strong knowledge of Group Insurance - Dental claims
• Customer service oriented
• Excellent communication skills both verbal and written
• Excellent problem solving skills
• Self motivated
• Team Oriented
• Ability to work in a changing environment
• Decision-maker
• Open to retroaction and giving feedback
• Bilingualism (French and English, verbal and written) nice to have

Your scope of work / key responsibilities:

• Review complex claims and estimates for completeness and follow processes for incomplete information on claims
• Assess and adjudicate complex claims and estimates
• Assessing includes studying dental information and plan provisions, researching, documenting results and communicating verbally and or in writing with the client (member/sponsor) to obtain additional details in order to make an informed decision
• Meet production and quality standards set for individuals, teams and department (timeliness, quality and service)
• Handle external and internal inquiries via written correspondence, e-mails and telephone as required

V.vaibhav@sunlife.com

Preferred candidate profile