Member Advocate Specialist, DentaQuest South TX ( Bilingual in Spanish) position at Sun Life Insurance.| United States Of America

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Sun Life Insurance Member Advocate Specialist, DentaQuest South TX ( Bilingual in Spanish)

Experience: 3-years

Pattern: full-time

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Associate

U.S. Telecommu..........United States Of America

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: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK. **Candidates must be located in Cameron or Hidalgo County in Texas. The o pportunity: The Member Advocate Specialist (MAS) has direct oversight for the advocacy of members included but not limited to preventive dental care, access to care, education, complaints and grievances, appeals, and dental home. In addition, attends virtual or in-person health fairs and community events, a s directed by business need . How you will contribute: Facilitate the delivery of preventive dental services for eligible members every six months beginning at six months of age.  Including e ngag ement of members via telephone to support outreach business objectives. Facilitate the delivery of preventive dental services for new members within 90 days of enrollment. Collaborate with other advocate specialists, Outreach Coordinators, and marketing department in the development of generic and customized outreach strategies for increasing dental access rates . Coordinate with community engagement of health plan and clients via virtual or in-person opportunities . Collect, compile and analyze information gleaned from virtual or in-person outreach initiatives/e vents in order to determine impact, and recommend changes that may make future outreach projects more effective. Establish and maintain community relationships that provide for participation in health care initiatives and programs to create dental awareness. These relationships will aid in the member advocate’s ability to refer members to community resources that can accommodate members’ needs if the services are not medically necessary covered dental services. Understand the cultural and socio-economic characteristics of their region(s). Assist members, either in person or via telephone, with writing complaints. Responsible for monitoring complaints through completion. Collaborate with customer service staff to ensure members are contacted for dental appointments to be scheduled in a timely manner (within 30 days for routine care /within 28 days for routine care in NY ). Establish and maintain a process to manage dental care and continuity of care for individuals with special health needs. Facilitate and support the dental home process in their region. This includes tasks such as assisting members with finding a dental home, coordinate case management for various populations including special needs and Children of Migrant Farm Workers (TX only ) , maintaining the data for reporting dental home activities, and coordinating outreach efforts. Submit tracking and trending reports related to dental home, member advocacy, migrant worker, care coordination and case management performance measures to DentaQuest management.  Identify disparities, opportunities for improvement and recommended solutions. Help maintain and increase dental access requirements in compliance with dental home components, Medicaid, CHIP and Frew guidelines (for TX only) . Adhere to DentaQuest business processes. Other duties as assigned. Collaborate with DentaQuest management, internal departments, state & local agencies and HHSC clients to plan, evaluate and implement activities to improve access and appropriate care to members. This includes making recommendations on changes that may improve either the care provided, or the way care is delivered. Ensure members receive educational materials upon enrollment regarding the services available through the Texas Health Steps program and how to obtain them. Educational material also includes information on: Member’s rights and responsibilities The complaint processes The appeal processes M edically necessary covered services available to them, including preventive services Non-capitated services (benefits that are excluded from medically necessary services such as transportation) Assist Children of Migrant Farm Workers receive prompt delivery of service, as they might transition into and out of the dental program more rapidly than the general population. This includes coordinating with their provider to make certain they receive preventive dental services prior to leaving Texas (“accelerated services”) if their routine checkup is scheduled after they leave Texas. Other duties as assigned. What you will bring with you : Bachelor’s degree and /or 3 years of related experience in healthcare, advocacy or customer service . Fluent in Spanish, both written and spoken. Demonstrated proficiency in claims processing and issue resolution. Knowledge of clinical and industry terminology and procedures. Demonstrated commitment to health and wellness. Self-motivated, and ability to work with little supervision. Strong analytical skills. Strong problem-solving skills and the ability to make independent decisions. Strong written and oral communication skills. Knowledge of general computer software. (Outlook, Excel and MS Word) Ability to communicate in an active office environment. Ability to travel throughout the State of Texas as needed. Valid Driver's License and Vehicle Insurance. Ability to efficiently operate all job-related office equipment. Ability to communicate via telephone and in writing. Ability to read and view computer screen. The department is in a wheelchair accessible building. The office environment is active with high voice levels and interruptions that may challenge hearing and concentration. Preferred: Background in education or community advocacy. Enjoys meeting and talking to people. Bilingual language skills preferred. Experience working in a managed care environment is preferred. Creativity in promoting events and implementation of events is preferred. Knowledge of healthcare advocacy activities is preferred Community Engagement Experience PHYSICAL DEMANDS: Incumbent must be able to communicate effectively.   Requires overall light physical effort (up to 25lbs.) Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal compute). Ability to travel or move about within and outside serviced facilities required.              Incumbent works primarily in either a private or shared office environment. Salary: Salary Range: $49,200 - $66,400 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. Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! 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 accommodation s to the known physical or mental limitation s 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 vetera n. Job Category: Customer Service / Operations Posting End Date: 29/01/2026

Member Advocate Specialist, DentaQuest South TX ( Bilingual in Spanish) job opportunity at Sun Life Insurance.

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