Clinical Review Support Specialist

Clinical Review Specialist I

The Clinical Review Specialist I provides timely and accurate review and authorization of dental services based on eligibility and contract requirements.

How you will contribute:

• Successful completion of the Clinical Review Specialist training program
• Read, interpret and analyze x-rays, models and requests for major dental services based on medical necessity, client coverage, provider participation and member eligibility, in accordance with contract language
• Resolve claim and prior authorization suspends that require UM Review
• Consistently meet productivity requirements
• Maintain audit score of 95% or greater
• Pass the IRR quarterly
• Communicate and work effectively with co-workers and Leads to coordinate workload to ensure all work is completed daily
• Knowledge of reference materials and documentation that contain market nuances
• Respond to follow-ups
• Provide customer service via the telephone to providers regarding clinical issues
• Other duties as assigned
• Represent DentaQuest in a professional manner at all times
• Adhere to DentaQuest business processes
• Performs peer clinical reviews

What you will bring with you:

• High School Diploma or equivalent
• 1 year dental assisting experience
• Ability to read and interpret x-rays, dental models, photos, and/or patient charts
• Good interpersonal skills
• Ability to work independently
• Excellent oral and written communication skills
• Efficient PC skills (Word, Excel, Outlook)
• Ability to prioritize and organize multiple tasks
• Ability to remain organized with multiple interruptions
• Knowledge of telephone systems
• Ability to work in excess of 40 hours in a week
• Required to attend additional training as required/deemed necessary
• Previous dental insurance experience a plus

Salary Range: $38,200 - $51,600

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.

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 View email address on click.appcast.io 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: Claims - Health & Dental

Posting End Date: 26/08/2026