Sun Life
Member Advocate Specialist, DentaQuest South TX ( Bilingual in Spanish)
Sun Life, South Portland, Maine, us, 04106
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.
DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes‑based, cost‑effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.
Job Description Location requirement:
Candidates must be located in Cameron or Hidalgo County in Texas.
Responsibilities
Facilitate the delivery of preventive dental services for eligible members every six months beginning at six months of age.
Engage members via telephone to support outreach business objectives and facilitate the delivery of preventive dental services for new members within 90 days of enrollment.
Collaborate with other advocate specialists, Outreach Coordinators, and marketing departments in developing generic and customized outreach strategies to increase dental access rates.
Coordinate with community engagement of health plans and clients through virtual or in‑person opportunities.
Collect, compile, and analyze information from virtual or in‑person outreach initiatives/events to determine impact and recommend changes that improve outreach effectiveness.
Establish and maintain community relationships that facilitate participation in healthcare initiatives and programs to create dental awareness, allowing members to be referred to community resources when services are not covered.
Understand the cultural and socio‑economic characteristics of their region(s).
Assist members, either in person or via telephone, with writing complaints.
Monitor complaints through completion.
Collaborate with customer service staff to ensure members are contacted for dental appointments to be scheduled in a timely manner.
Establish and maintain a process to manage dental care and continuity of care for individuals with special health needs.
Facilitate and support the dental home process in their region.
Assist members with finding a dental home, coordinate case management for special needs populations and Children of Migrant Farm Workers (TX only), maintain data for reporting dental home activities, and coordinate outreach efforts.
Submit tracking and trending reports related to dental home, member advocacy, migrant worker, care coordination, and case management performance measures to DentaQuest management.
Identify disparities, opportunities for improvement, and recommend solutions.
Help maintain and increase dental access requirements in compliance with dental home components, Medicaid, CHIP, and Frew guidelines (TX only).
Adhere to DentaQuest business processes.
Collaborate with DentaQuest management, internal departments, state & local agencies, and HHSC clients to plan, evaluate, and implement activities that improve access and appropriate care for members.
Make recommendations on changes that may improve the care delivered or its delivery method.
Ensure members receive educational materials upon enrollment regarding services available through the Texas Health Steps program and how to obtain them.
Provide educational material covering member rights and responsibilities, complaint processes, appeal processes, medically necessary covered services (including preventive services), and non‑capitated services (benefits excluded from medically necessary services such as transportation).
Assist Children of Migrant Farm Workers in receiving prompt service delivery, coordinating with their provider to ensure preventive dental services prior to leaving Texas (“accelerated services”) when needed.
Perform any other duties as assigned.
Qualifications
Bachelor’s degree and/or 3 years of related experience in healthcare, advocacy, or customer service.
Fluent in Spanish, both written and spoken.
Demonstrated proficiency in claims processing and issue resolution.
Knowledge of clinical and industry terminology and procedures.
Demonstrated commitment to health and wellness.
Self‑motivation and the ability to work with little supervision.
Strong analytical, problem‑solving, and decision‑making skills.
Excellent written and oral communication skills.
Proficiency with general computer software (Outlook, Excel, MS Word).
Ability to communicate in an active office environment.
Ability to travel throughout Texas as needed.
Valid driver’s license and vehicle insurance.
Ability to efficiently operate all job‑related office equipment, communicate via telephone and in writing, and read and view computer screens.
Preferred Qualifications
Background in education or community advocacy.
Enjoys meeting and talking to people.
Bilingual language skills preferred.
Experience working in a managed care environment.
Creativity in promoting events and implementing events.
Knowledge of healthcare advocacy activities.
Community engagement experience.
Physical Demands
Must be able to communicate effectively.
Requires overall light physical effort (up to 25 lbs).
Manual dexterity and sitting required while using a computer.
Ability to travel or move within and outside serviced facilities.
Incumbent works primarily in a private or shared office environment.
Salary Salary Range: $49,200 – $66,400. 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.
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 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 for 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.com 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 / Operations
Posting End Date:
29/01/2026
#J-18808-Ljbffr
Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.
DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes‑based, cost‑effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.
Job Description Location requirement:
Candidates must be located in Cameron or Hidalgo County in Texas.
Responsibilities
Facilitate the delivery of preventive dental services for eligible members every six months beginning at six months of age.
Engage members via telephone to support outreach business objectives and facilitate the delivery of preventive dental services for new members within 90 days of enrollment.
Collaborate with other advocate specialists, Outreach Coordinators, and marketing departments in developing generic and customized outreach strategies to increase dental access rates.
Coordinate with community engagement of health plans and clients through virtual or in‑person opportunities.
Collect, compile, and analyze information from virtual or in‑person outreach initiatives/events to determine impact and recommend changes that improve outreach effectiveness.
Establish and maintain community relationships that facilitate participation in healthcare initiatives and programs to create dental awareness, allowing members to be referred to community resources when services are not covered.
Understand the cultural and socio‑economic characteristics of their region(s).
Assist members, either in person or via telephone, with writing complaints.
Monitor complaints through completion.
Collaborate with customer service staff to ensure members are contacted for dental appointments to be scheduled in a timely manner.
Establish and maintain a process to manage dental care and continuity of care for individuals with special health needs.
Facilitate and support the dental home process in their region.
Assist members with finding a dental home, coordinate case management for special needs populations and Children of Migrant Farm Workers (TX only), maintain data for reporting dental home activities, and coordinate outreach efforts.
Submit tracking and trending reports related to dental home, member advocacy, migrant worker, care coordination, and case management performance measures to DentaQuest management.
Identify disparities, opportunities for improvement, and recommend solutions.
Help maintain and increase dental access requirements in compliance with dental home components, Medicaid, CHIP, and Frew guidelines (TX only).
Adhere to DentaQuest business processes.
Collaborate with DentaQuest management, internal departments, state & local agencies, and HHSC clients to plan, evaluate, and implement activities that improve access and appropriate care for members.
Make recommendations on changes that may improve the care delivered or its delivery method.
Ensure members receive educational materials upon enrollment regarding services available through the Texas Health Steps program and how to obtain them.
Provide educational material covering member rights and responsibilities, complaint processes, appeal processes, medically necessary covered services (including preventive services), and non‑capitated services (benefits excluded from medically necessary services such as transportation).
Assist Children of Migrant Farm Workers in receiving prompt service delivery, coordinating with their provider to ensure preventive dental services prior to leaving Texas (“accelerated services”) when needed.
Perform any other duties as assigned.
Qualifications
Bachelor’s degree and/or 3 years of related experience in healthcare, advocacy, or customer service.
Fluent in Spanish, both written and spoken.
Demonstrated proficiency in claims processing and issue resolution.
Knowledge of clinical and industry terminology and procedures.
Demonstrated commitment to health and wellness.
Self‑motivation and the ability to work with little supervision.
Strong analytical, problem‑solving, and decision‑making skills.
Excellent written and oral communication skills.
Proficiency with general computer software (Outlook, Excel, MS Word).
Ability to communicate in an active office environment.
Ability to travel throughout Texas as needed.
Valid driver’s license and vehicle insurance.
Ability to efficiently operate all job‑related office equipment, communicate via telephone and in writing, and read and view computer screens.
Preferred Qualifications
Background in education or community advocacy.
Enjoys meeting and talking to people.
Bilingual language skills preferred.
Experience working in a managed care environment.
Creativity in promoting events and implementing events.
Knowledge of healthcare advocacy activities.
Community engagement experience.
Physical Demands
Must be able to communicate effectively.
Requires overall light physical effort (up to 25 lbs).
Manual dexterity and sitting required while using a computer.
Ability to travel or move within and outside serviced facilities.
Incumbent works primarily in a private or shared office environment.
Salary Salary Range: $49,200 – $66,400. 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.
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 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 for 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.com 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 / Operations
Posting End Date:
29/01/2026
#J-18808-Ljbffr