Member Advocate Specialist, DentaQuest South TX ( Bilingual in Spanish

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.

Denta Quest 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.

Location requirement: Candidates must be located in Cameron or Hidalgo County in Texas.

• 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 Denta Quest 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 Denta Quest business processes.
• Collaborate with Denta Quest 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…