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: We support US flexible working arrangements in the contiguous 48 states.
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.
This role is responsible for managing all aspects of network contracting and reimbursement to assure a highly efficient network in accordance with the cost and quality requirements and guidelines within the program administration. The representative is responsible for building long-term relationships with provider offices and clients and negotiating on all provider contracting elements, reimbursement structure, technology promotion, and access to care. The role is responsible for provider negotiation, contracting and credentialing for all products, including Medicaid, Medicare Advantage, Marketplace and Direct to Consumer, Commercial and any blend of dental products. Negotiations and contract execution needs to take place with decision makers at the provider entities, including CEOs, Vice Presidents and other executive leadership at the provider offices as well as individual dentists depending on the office size, location and corporate entity.
Solicit and represent the DentaQuest brand to the provider community, including the potential network of providers and dental groups in assigned markets.
Effective negotiation of provider contracts and reimbursement.
Negotiate complex financial models including incentive programs, capitation or special deal contracts to maintain compliance and increase cost effectiveness and access to care as necessary.
Research competition in market and make recommendations to meet or exceed competition.
Build and maintain relationships with organized dentistry and other key stakeholders.
Create and lead presentations to dental advisory groups and other stakeholder organizations.
Obtain letters of recommendation from provider entities and individual providers that partner on pilot programs, efficiency projects and innovative solutions to effectively boost RFP responses and competitive positioning.
Continuous improvement on credentialing and contracting workflow process.
Ensure reports on status of providers are prepared accurately and distributed timely.
Provide recommended solutions to improving provider satisfaction.
Provide leadership and education to provider offices in filing credentialing apps electronically and support enrollment of EFTs and electronic EOBS.
Provide web portal training and support to providers for effective contracting and credentialing requirements.
Resolve escalated issues in a timely manner by working with the appropriate internal partners to ensure provider satisfaction and growth commitments from the network.
Develop and continually improve personalized presentations of company benefit programs and innovative solutions.
Recruit and contract participating and non-participating providers to higher levels of participation with additional products and improved business models.
Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations when appropriate.
Support the increase of access for members by strengthening and expanding existing network.
Adhere to DentaQuest business processes.
Other duties as assigned.
What you will bring with you:
Bachelor’s Degree in Business, Health Care Administration (or relevant field) or equivalent work experience.
5 years’ minimum heath care contracting, medical and/or hospital contracting or equivalent sales experience.
Strong presentation, negotiation, organization, analytic and presentation skills.
Demonstrated relationship building/negotiation experience
Ability to work remotely, with minimal supervision.
Excellent verbal and written communication skills.
Ability to work independently and as part of a team.
Proficiency in Microsoft Office products (Excel, Word & PowerPoint)
Ability to meet multiple deadlines and to prioritize and organize multiple tasks with tight deadlines.
Ability to work in high-pressure environment with tight deadlines for results
Preferred Qualifications:
Ability to effectively operate computer equipment.
Work schedule may vary and isdetermined 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
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.
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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
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 California resident, the salary range for this position is:
If you are a Minnesota, Colorado or Nevada resident, the salary range for this position is $74,100 - $111,200 annually
If you are anIllinois, Connecticut or Maryland resident, the salary range for this position is $77,600 - $116,400 annually
If you are Washington, Washington D.C., and Rhode Island resident, the salary range for this position is $81,800 - $122,700 annually
If you are a New York resident, the salary range for this position is $87,500 - $131,300 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.
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.
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.
Dental Network
19/12/2024
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
