Provider Partner, DentaQuest

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. DentaQuest manages dental and vision benefits for more than 33 million Americans, focusing on prevention and value to improve oral health.

About the role

The Provider Partner is the primary on-site point person for providers to improve their comprehension of our benefit programs, policies, and procedures. This role handles provider networks with regard to office education, technology promotion, network recruitment (expansion and strengthening utilization), and onboarding of newly contracted providers. The Provider Partner also administers on-site office reviews as required by network rules and regulations.

Responsibilities

• Analyze and monitor provider cost reports on an ongoing basis to educate and improve providers’ cost and quality performance.
• Maintain network participation by providing aid to dentists and dental office managers to improve their awareness of all available benefit programs.
• Educate providers on comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits, phone, and email.
• Promote dentist adoption of technology solutions by encouraging the use of Web applications and increasing the volume of electronic claims.
• Negotiate special deals to maintain compliance and increase access in weak networks.
• Recommend changes in internal methods and procedures to improve the Quality Assurance process.
• Facilitate Oral Health presentations to various educational institutions and organizations.
• Assist provider offices in filing claims electronically.
• Serve as a partner with dental offices by answering remittance, payment, benefit, claims, and eligibility questions.
• Follow up with all termination letters submitted.
• Represent clients and the company at trade shows, health fairs, audits, dental summits, etc.
• 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 a 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 levels of participation for all applicable market lines of business.
• 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.
• Assist in problem resolution by identifying improvement opportunities and evaluating the feasibility of programs.
• Develop and implement approaches to improve the quality of information exchanged between the company and dental offices.
• Resolve difficult claims issues in a timely manner by working with appropriate internal resources.
• Increase access for members by strengthening and expanding the existing network.
• Help maintain a secondary network.

Requirements

• Bachelor’s Degree in Business, Healthcare Administration, or related field (or relevant work experience).
• 3 years of related work experience in a healthcare environment.
• Dental knowledge with five (5) or more years of office experience, preferred.
• Strong presentation skills.
• Excellent verbal and written communication skills.
• Ability to work alone 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 sound judgments based on available data with minimal supervision.

Pay

The salary range for this role is $71,000 - $106,000. Your actual base salary will be determined based on skills, qualifications, experience, education, and geographic location. This position is also eligible for a discretionary annual incentive award based on individual and business performance.

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.
• Partially paid sabbatical program.
• 401(k) employer match.
• Stock purchase options.
• Employer-funded retirement account.
• Flexible, inclusive, and collaborative work environment supporting career growth.