Texas Dental Director, 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:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK. 

** Candidates must reside in the state of Texas.

The opportunity:

The Dental Director acts as a clinical subject matter expert for both internal entities and our clients in Texas. Their clinical expertise may be called upon reviews claims based on medical necessity, in accordance with market contracts, evaluate appeals, counsel providers, identify providers with aberrant utilization patterns, provide clinical support for provider outreach, and provide feedback on clinical policies.

How you will contribute:  

• Facilitate educational trainings for dental providers.

• Represent DentaQuest in a professional manner at all times when interacting with clients, management, employees, the provider community, dental associates, and other key stakeholders.

• Adhere to all DentaQuest policies, processes and procedures.

• Identify and recommend process and productivity improvement opportunities.

• Establish and maintain an understanding of dental program administration, including, but not limited to: benefit and authorization requirements for plans and/or states, claims payment and the denial process, and a business understanding of ASO and Risk relationships

• Develop a strong knowledge base and overall understanding of state and federal dental regulations.

• Proactively alert DentaQuest staff of potential state regulatory changes impacting dental benefits/administration.

• Act as a DentaQuest liaison to the provider community, offering educations sessions associated with our dental programs.

• Proactively identify and participate in activities, programs, and speaking engagements associated with Medicaid and Medicare Dental Programs

• Identify and recommend regional community related activities and events (e.g. Health Fairs, Dental Screenings, Back to School Programs, etc.) DentaQuest can participate in to further our mission.

• Establish and maintain an understanding of DentaQuest’s Oral Health Wellness and Outreach Programs.

• Review dental cases and represent DentaQuest at fair hearings, as needed or directed.

• Establish and maintain strategic relationships with regional dental associations and key stakeholders for the purpose of solidifying new business and/or maintaining existing business.

• Recruit qualified providers for DentaQuest networks as needed or directed.

• Perform other duties as assigned

What you will bring with you:  

Required:

• Graduate of an accredited Dental School (D.D.S. or D.M.D)

• Maintain an unrestricted dental license in the state of Texas.

• Must physically reside in Texas

• At least 5 years of clinical experience preferred

Preferred:

• Knowledge of general dentistry

• Public health experience a plus

• Efficient PC skills

• Ability to use analytical/presentation tools such as Excel and PowerPoint.

• Organizational and time management skills

• Ability to work with a team and independently to complete assigned tasks without supervision

• Ability to make independent determinations on all types of dental claims

• Excellent written and verbal communication skills

• Ability to distinguish between multiple market benefits

• Ability to prioritize and organize multiple tasks