Dental Claims Specialist

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.

As a Dental Specialist, you will be responsible for carrying out the claims examination process of dental claims with higher complexity, and providing the team with expert analysis of complicated or unusual claims. The Dental Specialist is responsible for ensuring the accurate and timely processing of complex claims and estimates for reimbursement to our members. This includes assessing dental x-rays and claims, reviewing complex claims for completeness and producing internal and external correspondence. There are clearly defined expectations with regards to service standards, productivity and quality targets and the maintenance of confidential information.

**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)
- 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

**What do you need to succeed?**
- 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
- Strong decision making skills
- Open to receiving and giving feedback
- As this position is posted in several locations, we specify that bilingualism (French, English, both oral and written) is required for Quebec only to answer calls from English and French-speaking clients across Canada or worldwide

**What’s in it for you?**
- We’re proud to be recognized as a company with a 2023 Most Trusted Executive team by Great Place to Work® Canada
- Access to short-term assignments or ‘Gigs’ across the organization, to help you develop new skills and connections.
- A collaborative and interactive team environment
- Charitable giving through our You Give, We Give program lets you give back to your community - and in many cases, we’ll match your contributions.
- Care Days available for self-care or care of others (i.e., family or others you may support) and Sick Days to support your well-being.

When a new position becomes available which matches your background and experience, the base pay range will be disclosed and correspond to the opportunity Sun Life will consider you for.

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.

We thank all applicants for showing an interest in this position. Only those selected for an interview will be contacted.

**Job Category**:
Claims - Health & Dental

**Posting End Date**:
05/01/2025