Complaints & Grievances Specialist II, DentaQuest at Sun Life

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 6400 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. Job Description: Location: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our team members and leaders are expected to foster connection and teamwork by being present in the office at least 2 days per week.The opportunity: The Complaints & Grievances Specialist II handles for the investigation and resolution of complaints grievances and member appeals based upon specific regulatory addition responsible for the assembly and preparation of Maximus packets State Fair Hearing packets as well as coordination and participation in State Fair Hearings. Accountable for daily interaction with assigned market/client contacts as well as various internal departments. This position also ensures that all mandated turnaround times are met as well as required processes and workflows are adhered to.How you will contribute:Investigate and resolve complaints and grievances in accordance with State and/or Plan guidelines. Ensure all components of the grievance/complaint are researched and addressed. Complaints/grievances that this role is responsible for include:Member Complaints/GrievancesMember Complaints/Grievances submitted by plan (when DQ is secondary)Provider ComplaintSDOH (State Department of Health) complaintsDOI (Department of Insurance) complaintsBBB (Better Business Bureau) complaintsExecutive complaints (complaints addressed to executives of DentaQuest)Any other complaints/grievance submitted as part of the formal grievance processPrepare State Fair Hearing packets and coordinate scheduling State Fair Hearing reviewsAssemble necessary information for the plan so they may appropriately investigate member appeals/complaints when we are not delegated.Monitor shared mailboxes and department e-mails to ensure cases are properly entered into department tracking system and that requests are acknowledged and resolved timely and accurately. Manage workflow to meet department Plan State and company goals and deadlines.Comply with and resolve proof of compliance and directives.Contact involved provider office to obtain information to properly review the case. Document providers/staffs perception of the members concerns / issues.Document all complaints/grievances/appeals in department tracking systemWhat you will bring with you:High School Diploma or GED required.1 year of C&G experience with demonstrated success in C&G Specialist I or 2 years experience in claims customer service provider network or another operational function.Proficient with general computer software including Microsoft Excel Word and Outlook.Excellent verbal written interpersonal organizational and communication skills.Excellent research skills with ability to identify underlying issue(s) not articulatedAbility to remain calm and focused in a high pressure/high workload environmentAbility to work in a high stress environment.Ability to prioritize and organize multiple tasks with tight deadlines.Ability to remain organized with multiple interruptions.Ability to work overtime as needed or required to meet business objectives.Salary: $49200 - 66400At 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 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 LifeAt 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. Were proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S. weve also been recognized as a Top 10 employer by the Boston Globes 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 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: Customer Service / OperationsPosting End Date: 08/01/2026Required Experience:IC Key Skills Sales Experience,Crane,Customer Service,Communication skills,Heavy Equipment Operation,Microsoft Word,Case Management,OSHA,Team Management,Catheterization,Microsoft Outlook Calendar,EHS Employment Type : Full-Time Experience: years Vacancy: 1 Monthly Salary Salary: 49200 - 66400