Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Job Description:

Location: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work.

The Opportunity:
The Manager, Vision Utilization Management & Claims Operations is accountable for managing operational service level agreements by monitoring workflows, allocating work, and auditing performance. In addition, the Manager, Vision UM & Claims Operations governs for operational escalations to ensure performance and process excellence are achieved. Must have the ability to motivate team members, drive change, identify areas of improvement, and recommend/implement changes as necessary to ensure compliance and efficiency within Operations.

How you will contribute:

• Manage operational metrics for all vision functional areas as defined per contractual and regulatory requirements.
• Manage daily forecast to ensure proper utilization of labor and overtime to achieve the maximum service levels within budget.
• Manage projects and process improvements directly related to Operations functions to meet contractual and regulatory requirements. Provide Leadership with weekly updates on project status. Ensure timely responses and implementation of changes/updates.
• Discern and utilize productivity, systems, and claims reports to ensure productivity, accuracy, minimize adjustments, and implement efficiencies.
• Respond to RFP requests as related to UM & Claims Operations.
• Collaborate with Contract Compliance Associate to draft CAP answers related to UM & Claims Operations.
• Solution daily ad hoc claim administrative tasks from all constituents.
• Assist with managing vision systems vendor relationships, contracts, SLAs, projects, and costs.
• Complete Operational dashboards, examine data and address productivity and accuracy issues.
• Ensure all vision process documentation & SharePoint are current and changes communicated timely.
• Ensure all systems issues are reported to the systems vendor. Monitor and escalate appropriately to resolution.
• Represent vision at client meetings for UM & Claims Operations.
• Serve as Vision Operations Leader for enterprise-wide implementation initiatives for new & existing products/business/clients.
• Coordinate and implement appropriate performance management strategies for team members to include:
• Assist in the hiring process, including interviewing candidates.
• Assist, train, and motivate team members.
• Evaluate and measure the effectiveness of team members.
• Assist in the preparation of performance and wage evaluations in accordance with company policy.
• Accountable for attendance and company-approved time off for team members.
• Participate in the motivation and implementation of Performance Improvement Plans and performance management initiatives.
• Other duties as assigned.

What you will bring with you:

• Bachelor's degree in business, Healthcare Administration (or related field) or five years' relevant industry experience in healthcare or insurance with demonstrated progressive levels of responsibility, experience, and supervision.
• Previous leadership/management experience, preferred
• Experience with CPT and ICD Coding, preferred
• Knowledge of benefits and insurance.
• Knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines for Medicare and Medicaid. National Committee for Quality Assurance (NCQA), State Medicaid regulations or compliance requirements
• Previous supervisor/training experience
• General knowledge of vision and eye care
• Experience with CPT and ICD Coding, knowledge of clinical and industry terminology and procedures
• Knowledge of benefits and insurance
• Well-organized and exceptional organizational, written, and oral communication skills, particularly presentation skills.
• Project Management experience.
• Demonstrated ability to influence outcomes.
• Ability to work without supervision and as part of a team.
• Proficient with general computer software including Microsoft Excel, Word and Outlook.
• Proven problem-solving skills.
• Ability to make good judgment conclusions based on data available with minimal supervision.
• Ability to prioritize and organize multiple tasks with tight deadlines.
• Attends additional training as requested/deemed necessary.

Salary: $52,500 - 78,800
At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work® Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.com to request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Category:

Claims - Health & Dental

Posting End Date:

15/05/2025