Kentucky Provider Partner Consultant, 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. 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 live in the Southwest area of Kentucky.

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 Consultant handles developing and managing relationships with providers within their assigned market.  As such, this role spends most time communicating with providers about suite of benefit programs (Medicaid, Medicare Advantage, Marketplace and Direct to Consumer and Commercial and any blend of dental products) to aid DLR in risk markets, and the P&L of the network. The Provider Partner Consultant works collaboratively with reporting to discern provider reports and promote continuous improvement top Providers (high performance metrics, cost, outliers, quality, etc.)

How you will contribute:

• Maintain visibility within their market, with an eye toward managing their network across all product lines.

• Evaluate and monitor provider cost reports on an ongoing basis to educate and improve providers’ cost and quality performance.

• Handles recruiting new providers and maintaining network participation by aiding dentists and dental office managers to improve their awareness of all available benefit programs.

• Responsible for educating providers, serve as primary point of contact for instruction 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.

• 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.

• Represent clients and company at trade shows, health fairs, audits, dental summits, etc. throughout the designated market and/or state.

• Governs creation and submission of all required reports.

• Acts as a subject matter expert for their respective geographic area

• Develop complete grasp of the Office Reference Manuals for implementation within their region.

• Develop and continually improve personalized presentations of company benefit programs

• Provide recommended solutions to market related issues.

• Measure impact of provider satisfaction (as tied to annual objectives of the team) and respond to provider 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.

• Performs in depth investigation of fee schedules, including fee schedule comparisons, to negotiate competitive custom fee schedules where needed

• Provides regular updates to senior management on internal and external issues affecting network market performance.

• Develop and implement processes to improve overall client and provider satisfaction

• Develop and maintain relationships with appropriate functio