You are as unique as your background, experience and point of view. Here, you'll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.
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.
Location: Candidate must be located in the Denver Metro Area.
At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you'll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.
The opportunity:
The Provider Partner is the primary on-site point person for providers to improve their understanding of our benefit programs, policies and procedures. The Provider Partner is responsible for provider networks with regard to office education, technology promotion, network recruitment (expansion and strengthening utilization), and onboarding of newly contracted providers. The Provider Partner is also responsible for administering on-site office reviews as required by network rules and regulations.
How you will contribute:
- Analyze and monitor provider cost reports on an ongoing basis in order to educate and improve providers' cost and quality performance.
- Maintain network participation by providing support to dentists and dental office managers to improve their understanding of all available benefit programs.
- Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporation's benefits and contracts through office visits and communication over the phone and email.
- Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.
- Negotiate special deals to maintain compliance and increase access in weak networks.
- Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.
- Facilitate Oral Health presentations to various educational institutions and organizations.
- Assist provider offices in filing their claims electronically.
- Serve as a partner with dental offices by answering remittance, payment, benefit, claims, and eligibility questions when necessary.
- Follow up with all termination letters submitted.
- Represent clients and company at trade shows, health fairs, audits, dental summits, etc. throughout the designated market.
- Maintain and submit all required reports.
- Assist in resolving elevated complaints and issues for clients, members and providers.
- Obtain letters of recommendation from providers.
- Develop complete understanding of the Office Reference Manuals.
- Develop and continually improve personalized presentations of company benefit programs.
- Recruit participating and non-participating providers to higher level of participation for all applicable market LOBs.
- Manage CAP office performance.
- Provide recommended solutions to market related issues.
- Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental related activities.
- Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations when appropriate.
- Develop and implement approaches by working with dentists and their office staff to improve the quality of information exchanged between the company and dental offices.
- Resolve difficult claims issues in a timely manner by working with the appropriate internal resources to research and resolve such issues.
- Increase access for members by strengthening and expanding existing network.
- Help to maintain a secondary network.
What you will bring with you:
Required:
- Bachelor's Degree in Business, Healthcare Administration or related field (or relevant work experience).
- 3 years' related work experience in healthcare environment.
- Strong presentation skills.
- Excellent verbal and written communication skills.
- Ability to work independently and as part of a team.
- Knowledge of Microsoft Office.
- Proven problem-solving skills.
- Up to 50% local travel required.
- Problem solving and training experience.
- Ability to make good judgment conclusions based on data available with minimal supervision.
Preferred:
- Dental knowledge with five (5) or more years of office experience.
- Managed Care experience.
Physical Demands:
- Ability to work in a traditional professional office setting or remote equivalent.
- Ability to effectively operate computer equipment.
- Work schedule may vary and is determined by project schedules.
- Ability to travel as projects dictate.
- Ability to efficiently operate all job-related office equipment.
- Ability to communicate via telephone and work in virtual teams.
- The office environment is active with high voice levels and interruptions that may challenge hearing and concentration.
Do you see yourself in this role even if you haven't checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.
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!
Life is brighter when you work at Sun Life
* Excellent benefits and wellness programs to support the three pillars of your well-being - mental, physical and financial - including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more.
* Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account.
* A flexible work environment with a friendly, caring, collaborative and inclusive culture.
* Great Place to Work Certified in Canada and the U.S.
* Named as a "Top 10" employer by the Boston Globe's "Top Places to Work" two years running.
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.
If you are a Colorado resident, the salary range for this position is $66,200 - $99,300 annually.
We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.
Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
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Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation 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 recruitingUS@sunlife.com to request an accommodation.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
Job Category: Sales - Client Relationship Management
Posting End Date: 03/10/2024
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