Sun Life · 1 month ago
Complaints & Grievances Specialist II, DentaQuest (IOWA)
Des Moines, Iowa
Full-time
Onsite
Entry, Mid Level
1+ years expSun 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. The Complaints & Grievances Specialist II is responsible for investigating and resolving complaints and grievances based on regulatory requirements, as well as preparing necessary documentation for State Fair Hearings and ensuring compliance with mandated processes.
FinanceFinancial ServicesInsurance
Responsibilities
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:
Prepare State Fair Hearing packets and coordinate scheduling State Fair Hearing reviews
Assemble 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 provider's/staff's perception of the member's concerns / issues
Document all complaints/grievances/appeals in department tracking system
Qualification
Required
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 articulated
Ability to remain calm and focused in a high pressure/high workload environment
Ability 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
Benefits
Generous vacation and sick time
Market-leading paid family, parental and adoption leave
Medical coverage
Company paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
401(k) employer match
Stock purchase options
Employer-funded retirement account
Company
Sun Life
Sun Life is a leading financial services organization dedicated to helping people achieve lifetime financial security and live healthier lives.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$1.05B2024-05-13Post Ipo Debt· $548.79M
2023-07-04Post Ipo Debt· $500M
2000-03-24IPO
Leadership Team
Kevin Strain
President & CEO
Luc Nhon Ly
Chief Executive Officer
Recent News
2025-12-02
MarketScreener
2025-12-02
South China Morning Post
2025-11-27
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