Sun Life

Sr. Clinical Dental Advisor, DentaQuest

Wellesley Hills, Massachusetts · Senior

Sponsorship not specifiedDetected 2 days ago

Code ReviewCommunicationCollaboration

About the role

Clinical Dental Advisor acts as the primary professional authority on service authorizations and medical necessity determinations.
This role ensures that dental services requested by providers comply with state and federal Medicaid regulations, evidence-based standards and dental plan policies.
Prior Authorization (PA) review and authorization: Evaluate dental requests (including x-rays and clinical notes) for appropriateness, completeness, and adherence to Oregon Administrative Rules (OARs); make service authorization decisions.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.
Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals.

Ability to interpret complex clinical data and radiological evidence to make defensible authorization decisions
Ability to work independently.
Ability to prioritize and organize multiple tasks.
Ability to remain organized with multiple interruptions.
Required to attend additional training as requested/deemed necessary.

Strong interpersonal skills.
Excellent oral and written communication skills for writing technical correspondence and testifying in hearings

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.
We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.
DentaQuest manages dental and vision benefits for more than 33 million Americans.
With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.
Evaluate dental requests (including x-rays and clinical notes) for appropriateness, completeness, and adherence to Oregon Administrative Rules (OARs); make service authorization decisions.
Evaluate requests from General Dentists for specialty services (e.g. endodontics, oral surgery) to confirm the clinical basis and compliance with dental plan benefits.
Represent dental plan in administrative hearings as expert witness.
Participate in the dental plan Peer Review and Credentialing committee.

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.

This listing is sourced directly from Sun Life's careers page and normalized into a canonical job model.