Clinical Review Support Specialist

January 1

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Sun Life

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10,000+ employees

Founded 1865

💸 Finance

Description

• The Clinical Review Specialist provides timely and accurate review and authorization of dental services based on eligibility and contract requirements • Read, interpret and evaluate x-rays, models and requests for major dental services based on medical necessity, client coverage and member eligibility • Resolve claim and prior authorization suspends that require UM Review • Consistently meet productivity requirements • Maintain audit score of 95% or greater • Communicate and work effectively with co-workers and Team Leads to coordinate workload

Requirements

• 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 mental, physical and financial well-being • Generous vacation and sick time • Market-leading paid family, parental and adoption leave • Partially-paid sabbatical program • Medical plans • Company paid life and AD&D insurance • Disability programs • Retirement and Stock Purchase programs including a 401(k) plan with employer-paid match • Flexible work environment with a friendly and inclusive culture