• Manage all components of claim handling for the Management Liability line of business • Independently review submitted materials and policy documents • Perform complete coverage analysis and prepare coverage determination correspondence • Review and provide direction on reserve and settlement authority • Support business partners through communication about specific claims and identification of claim trends • Monitor claim quality and customer feedback to ensure compliance with regulatory requirements

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: Must reside in Iowa The opportunity:  The Appeals Specialist II handles the investigation and resolution of all administrative and clinical appeals based upon specific regulatory and or client requirements. In addition, this position assembles and prepares responses to clients, members and/or providers. This position has daily interaction with assigned market/client contacts, as well as various internal departments. This position also ensures that all mandated turnaround times are met as well as required processes and workflows are adhered to. How you will contribute:  - Investigate, document, and resolve member and provider appeals and inquiries related to appeals in accordance with State and/or Plan guidelines. Ensure all components of the appeal or request for information are researched and addressed. - Assemble necessary information for the client so they may appropriately investigate an appeal when DentaQuest is secondary. If contracted to do so, also investigate the appeal and provide recommended outcome and appropriate correspondence. - Manage workflow to meet department, Plan, State, and company goals and deadlines. - Comply with and complete any client directives or overturns. - Collaborate and partner with Complaint & Grievance team to resolve common issues or trends. - Take the lead in working with other internal departments/management team to ensure that any trends identified in appeals are communicated and rectified. - Keep abreast of changes in market requirements and demonstrate expert knowledge in specific market nuances. - Identify and resolve issues that are unusual and not consistent with standard workflows. - Establish and maintain professional relationships with Plan contacts. - Contact involved provider office to obtain information to properly review the case. Document and summarize member’s and provider’s concerns / issues in a concise and easily readable format. - Ensure all letter templates in use are correct and most recent versions are used. - Identify areas for improvement. What you will bring with you:  - High School Diploma or GED required. - 1+ years experience in healthcare operations or appeals; or related field. - Previous experience in claims billing or prior authorizations, preferred - Proficient with general computer software including Microsoft Excel, Word and Outlook. - Excellent verbal, written, organizational and communication skills. - Excellent research skills with ability to identify underlying issue(s) even if 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. - Other duties, as assigned 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 to 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: 02/04/2026

Who We Are We’re Dealer Tire, a family-owned, international distributor of tires and parts established in 1918 in Cleveland, OH. We’re laser focused on helping the world’s largest and most trusted auto manufacturers grow their tire business—in fact, we’ve sold more than 60 million tires to date. We’re a thriving company, and we’re looking for driven individuals to join our team. That’s where you come in! Base Pay Range: $28.34 - $30.85 Targeted Annual Commission: $13,200 What’s In It For You We have a dedicated crew of more than 550 passionate and innovative Tire Service Advisors throughout the United States. Here are a few reasons why we’d make a great team: - Career Opportunity: Our training and development programs prepare you for growth and advancement. Within our Tire Store program, Dealer Tire proudly promoted an average of 114 team members per year over the last two years. - We respect your need for work-life balance. Our specialists have more personal time each day than hours spent at work, and a 40 hour, 5-day work week. - We invest in our employees. We offer $27.78 - $30.25 to start, $10,800 in targeted annual commission. To support your training and onboarding, we provide you with guaranteed commission for up to two months. - Benefits and Perks. Medical, Dental, Vision insurance plus a 50% 401k match up to a 7% contribution rate, PTO eligible after 30 days. Additional perks of wellness programs, annual tuition reimbursement between $2,500-$5,000, and discounts on tires! - Our employees are happy. Nearly 98% of our associates said they would highly recommend working at Dealer Tire to others. But hear it for yourself: Check out this video to see what our Tire Service Advisors have to say about working at Dealer Tire. The Opportunity As a Tire Service Advisor, you will work for Dealer Tire inside a premium OEM dealership. If you are an innovative individual who performs with excellence, energy, fairness, and accountability, then consider a future with Dealer Tire. Responsibilities - Selling tires to customers on the service drive to exceed assigned sales goals. - Inspecting customers’ cars on the service drive. - Diagnosing tire-related problems, recommending service, and quoting prices. - Assuring necessary repairs are completed as ordered and priced as quoted. - Maintaining strong, effective relationships with customers and dealer personnel. - Overseeing customer satisfaction and solving problems that arise. - Completing monthly market analyses. - Assisting in store operations (i.e. maintaining inventory, opening/closing the store, etc.). - Assisting dealership technicians to ensure service levels are maintained. Qualifications - 2+ years of tire service experience, preferably in a retail tire and service environment. - Excellent verbal communication skills with strong customer service orientation. - May be required to operate a motor vehicle. - Meet the requirements of Dealer Tire’s Motor Vehicle Record Policy and Company Vehicle Fleet Policy. - Proficient computer skills to include experience with MS Office and online order management applications. Physical Job Requirements This position requires applicants to be able to be on their feet 7-8 hours a day. Must be able to keep up with service drive traffic and inspect 80-100 vehicles a day. Applicants also must be able to lift up to 75 pounds unassisted. Drug Policy Dealer Tire is a drug-free environment. All applicants being considered for employment must pass a pre-employment drug screening before beginning work. Random drug testing for all Dealer Tire Store associates also is required. If this sounds like an opportunity that is the right fit for you, then we invite you to apply today to join our team! Why Dealer Tire: An amazing opportunity to join a growing organization, built on the efforts of hard working, innovative, and team-oriented people. The compensation offered for this position will depend on qualifications, experience, and geographic location. The total compensation package may also include commission, bonus or profit sharing. We offer a competitive & comprehensive benefit package including: paid time off, medical, dental, vision, and 401k match (50% on the dollar up to 7% of employee contribution). For more information on our benefit offerings, please visit our Dealer Tire Family of Companies Benefits Highlights Booklet. EOE Statement: Dealer Tire is an Equal Employment Opportunity (EEO) employer and does not discriminate on the basis of race, color, national origin, religion, gender, age, veteran status, political affiliation, sexual orientation, marital status or disability (in compliance with the Americans with Disabilities Act*), or any other legally protected status, with respect to employment opportunities. *ADA Disclosure: Any candidate who feels that they may need an accommodation to complete this application, or any portions of same, based on the impact of a disability should contact Dealer Tire’s Human Resources Department to discuss your specific needs. Please feel free to contact us at 1-800-933-2537 x6550.

Job Description Investigate and settle advanced, large loss, complex claims promptly and equitably under minimal supervision. Works within established authority on moderate-to-difficult claims. Reviews coverages, determines liability and compensability, secures information, arranges property damage appraisals, and settles claims utilizing claims best practices. Evaluates and sets reserves using independent judgment. Assists the supervisor and company attorneys in preparing cases for litigation. Conducts training and mentors new hires. Responsibilities - Interprets and makes decisions using independent judgment on more complex and unusual policy coverages and determines if coverages apply to claims submitted. - Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel. - Analyzes claims activity and prepares reports for clients/carriers and management. - Establish reserves, using independent judgment and expertise, and authorize payments within the scope of authority, settling claims in the most cost-effective manner and ensuring timely issuance of disbursements. - Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits. - Develops subrogation and third-party recovery potential and follows reclaim procedures. - Analyzes claims activities and prepares reports for clients, carriers, and/or management. Participates in claim reviews. Qualifications - Bachelor's degree or equivalent experience required. Industry designations preferred but not required (IIA, AIC, AEI, and/or CPCU). - Technical claims investigations/settling experience with 4-8 years of experience in Claims or a similar organization. - Ability to work independently while assimilating various technical subjects. - Strong written and oral communication, negotiation, and presentation skills. - Advanced analytical and problem-solving skills, with the ability to manage and prioritize multiple projects. - Effective advanced interpersonal skills to interact effectively with all levels of internal and external clients. - Workers' Compensation (WC) Adjuster License required according to jurisdictional requirements Desired experience: - History using Independent Medical examinations (IMEs) and Medical Record Reviews (RRs) to effectively manage the Longshore claims  - An understanding of Longshore and Harbor Workers’ Compensation Act (LHWCA) rules pertaining to IMEs and RRs, including but not limited to: - Reasonable notice and distance to the exam date - Travel Expenses - No Show consequences - Experience managing Longshore and Defense Base Act claims in multiple jurisdictions, including but not limited to CA, FL, LA, and TX. - Technical Longshore claims investigations/settling experience with 5-8 years of experience in Longshore Claims or a similar organization.