Clinical Review Support Specialist

Sun Life

Clinical Review Support Specialist authorizing dental services for Sun Life’s DentaQuest benefits operations. Reviewing x-rays, eligibility, coverage, and prior authorizations.

Posted 8/20/2026full-timeMilwaukee • Montana, Wisconsin • 🇺🇸 United StatesJunior💰 $38,200 - $51,600 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in interpreting x-rays and dental models while ensuring compliance with clinical review standards. Proficient in customer service and communication, with a strong ability to manage multiple tasks efficiently.

Highest-signal resume keywords

X-Ray InterpretationDental Assisting ExperienceOral And Written Communication SkillsPC Skills (Word, Excel, Outlook)Dental Insurance Knowledge

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

X-Ray AnalysisDental Model InterpretationClaim ResolutionPrior Authorization ReviewAudit Compliance

Soft Skills

Interpersonal SkillsOrganizational SkillsIndependent Work AbilityEffective Communication

Tools & Technologies

Telephone Systems

Industry Keywords

Clinical Review SpecialistDentaQuest Business ProcessesProductivity RequirementsPeer Clinical ReviewsMedical Necessity

About the role

Key responsibilities & impact

Complete 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 an audit score of 95% or greater
Pass the IRR quarterly
Communicate and work effectively with co-workers and Leads to coordinate workload and ensure all work is completed daily
Use reference materials and documentation containing market nuances
Respond to follow-ups
Provide telephone customer service to providers regarding clinical issues
Perform other duties as assigned
Represent DentaQuest professionally
Adhere to DentaQuest business processes
Perform peer clinical reviews

Requirements

What you’ll need

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

Benefits

Comp & perks

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
Flexible, inclusive and collaborative work environment
Career growth support