Quality & Oversight Analyst, DentaQuest

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.

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.

The Opportunity:

The Quality Analyst for the Quality oversight team is responsible for preparing, inspecting, and complying with contractual quality program requirements. In this role you will validate and/or develop improved standards, identify training needs, including root-cause analysis, and correction actions/recommend solutions for the Quality oversight department within Compliance.

How you will contribute:

• Conduct comprehensive quality assurance assessments and audits to identify deviations, defects and non-conformities with processes and service level metrics. Report deficiencies to management.

• Develop and implement quality control audit plans.

• Training employees on quality standards and procedures.

• Preparing and presenting quality reports to senior management.

• Track and trend root cause analysis and corrective actions to address quality issues.

• Maintain quality meeting minutes for client distribution.

• Attending and participate in client meetings.

• Track quality contractual requirements and insure compliance of such requirements.

What you will bring with you:

• Solid understanding of NCQA and/or URAC requirements.

• Detail oriented and organized with the ability to prioritize tasks and meet deadlines.

• Strong analytical and problem-solving skills with the ability to conduct root cause analysis and implement corrective actions.

• Accountable for contributing to a workplace environment that fosters mutual respect, cooperation, information sharing and commitment to delivering the expected service.

• Broad knowledge of Medicaid administration.

• Knowledge of federal and state laws/regulations applicable to quality and processes

• Ability to think creatively to resolve the more complex or non-routine issues.

• Strong written and verbal communication skills and experience.

• Ability to effectively coach, develop and motivate team member to achieve Department and SLF goals

• Strong negotiation, decision making and problem-solving skills and experience

• Ability to develop and maintain effective, professional business relationships across all levels of the organization and external TPA administrators and customers

• Strong PC Proficiency

• Ability to successfully meet deadlines and achieve goals

• Knowledge of company computer systems and products

Salary Range: $50,500 - $75,800

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.comto 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.