[Remote] Sr. Clinical Dental Advisor, DentaQuest

Note The job is a remote job and is open to candidates in USA. Sun Life is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. The Sr. Clinical Dental Advisor acts as the primary professional authority on service authorizations and medical necessity determinations, ensuring compliance with regulations and standards while maintaining productivity and quality. Responsibilities Prior Authorization (PA) review and authorization Evaluate dental requests (including x-rays and clinical notes) for appropriateness, completeness, and adherence to Oregon Administrative Rules (OARs); make service authorization decisions Specialty Referral Review Evaluate requests from General Dentists for specialty services (e.g. endodontics, oral surgery) to confirm the clinical basis and compliance with dental plan benefits. Act as a “scope of practice” auditor to prevent unnecessary specialist referrals for procedures the referring General Dentist is contractually or professionally capable of performing, thereby managing utilization costs and member access Medical Necessity Determination Use professional judgment and evidence-based criteria to approve or deny service requests Provider Consultation Communicate directly with dental providers to clarify documentation or provide clinical justification for treatment alternatives Represent dental plan in administrative hearings as expert witness Participate in the dental plan Peer Review and Credentialing committee Expert in specific market nuances Consistently exceed productivity requirements Identify areas for process improvements within the department Other duties as assigned Skills Must hold a DDS or DMD degree with an active Oregon dental license and extensive clinical experience Deep understanding of Oregon Administrative Rules (OARs) and CDT coding systems Ability to interpret complex clinical data and radiological evidence to make defensible authorization decisions Strong interpersonal skills Ability to work independently Excellent oral and written communication skills for writing technical correspondence and testifying in hearings Ability to prioritize and organize multiple tasks Ability to remain organized with multiple interruptions Required to attend additional training as requested/deemed necessary 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 A partially paid sabbatical program 401(k) employer match Stock purchase options Employer-funded retirement account Flexible, inclusive and collaborative work environment that supports career growth Company Overview Sun Life is a leading financial services organization dedicated to helping people achieve lifetime financial security and live healthier lives. It was founded in 1865, and is headquartered in Toronto, Ontario, CAN, with a workforce of 10001+ employees. Its website is https//

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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