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.

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.

Location: We support US virtual working arrangements in the contiguous 48 states.

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.

The opportunity:
The Member Enrollment Analyst (MEA) is a leader; accountable for the coordination, implementation, and training of all processes related to eligibility EDI 834. This role has a general knowledge of all clients’ electronic enrollment (EE) files to prioritize and coordinate the running of EE files. Handles high profile, critical client implementations, from onset to implementation, and ensures membership accuracy within the system. The MEA will exhibit the highest level of knowledge of the EE process and membership data, and assist in the reconciliation of the claims system’s membership data to our financial system.

How you will contribute:

• Document client-specific eligibility business rules using tools such as Word, Visio and Excel; communicate business rules to IT.
• Discern and utilize the IT applications and tools used to aid data mapping, business rules, and HIPAA compliance; work with IT to implement technical aspects of system and data configurations based on business rules.
• Manage new eligibility EDI electronic enrollment (EE) implementations and changes to existing clients’ EE files through conference calls, e-mails, on-site visits, and ongoing customer communication.
• Author and maintain HIPAA 834 and Proprietary Companion Guides that enables clients to comply with processing requirements and reduce errors.
• Manage a high volume of projects and tasks with different priorities.
• Facilitate team meetings to share information related to membership and EE; ensure issues are communicated and understood by the team.
• Develop and maintain comprehensive schedules related to the status of new EE business; communicate regular statuses to Client Engagement, Sales, and other impacted departments.
• Perform monthly membership data reconciliation utilizing the HIPAA 834 EDI files; work closely with Client Engagement to review and communicate results.
• Partner with IT to implement new requirements; define requirements, approve Use Cases, perform user acceptance test (UAT), and approve code fixes into production.
• Prioritize EE files; work with supervisor to coordinate resources to accommodate the timely processing of files and meet or exceed service levels.
• Design, develop, and execute SQL queries to identify root cause where problems exist within membership data.
• Provide excellent customer service by responding to membership-related inquiries in a timely and accurate manner; may require extensive research with diverse resources.
• Establish and maintain membership data via EE files; manage timely and accurate processing of files to ensure all systems have correct data.
• Identify EDI solutions to business needs and constantly improve the effectiveness of our communications as they relate to eligibility and membership.
• Proactively communicate and coordinate eligibility issues with Sales, Client Engagement, and Customer Service and impacted departments; work collaboratively with these departments to develop solutions.
• Maintains company goals by participating on and providing eligibility EDI expertise to departmental and company projects.
• Assist clients in the interpretation and management of membership and eligibility reports.

What you will bring with you:

• Bachelor’s degree and related EDI or Business Analyst experience.
• Minimum 3 years of technical experience, preferably with EDI.
• In depth knowledge of EDI Healthcare-related file formats, including HIPAA 834, required.
• Deep functional understanding and hands-on experience implementing the 834 transaction.
• EDI ‘source to target’ transaction mappings (834 and proprietary files).
• Spearhead and drive projects and teams successfully.
• Strong supervision and communication skills to drive compliance with eligibility EDI (EE) requirements among submitting constituents (i.e. clients).
• Unsupervised and strategic decision making.
• Excellent organizational and time management skills; ability to handle multiple projects and priorities.
• Demonstrates self-motivation by taking initiative to learn more and take on more duties.
• Embrace change; positively influence change.
• Working knowledge of SQL and database and system design; capable of writing and running SQL queries.
• Ability to work without others without close supervision.
• Microsoft Office (Word, Excel, PowerPoint, Visio).
• Specific knowledge of enrollment processes in a commercial, Medicaid, or Medicare Health Plan/TPA organization.
• Working knowledge of FTP.
• Excellent reasoning skills
• EDI technical skills specifically using the 834 member enrollment transaction set, preferred
• Excellent communication skills - both verbal and written
• Relationship building
• Excellent customer service skills

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.

Not ready to apply yet but want to stay in touch? Join our talent community (https://pages.beamery.com/sunlifecareers/page/join-us-canada to stay connected until the time is right for you!

Life is brighter when you work at Sun Life

• Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account
• A flexible work environment with a friendly, caring, collaborative and inclusive culture
• Great Place to Work® Certified in Canada and the U.S.
• Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running

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.

If you are a California resident, the salary range for this position is:

• Southern region: $45,700 - 61,600 annually
• Central region: $48,100 - 65,000 annually
• Northern region: $51,500 - 69,400 annually

If you are a Colorado resident, the salary range for this position is $43,600 - 58,800 annually.
If you are a New York resident, the salary range for this position is $51,500 - 69,400 annually.
If you are Washington resident, the salary range for this position is $48,100 - 51,500 annually.

We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.

Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.

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.

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation 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 recruitingUS@sunlife.com to request an accommodation.

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.

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