Dental Provider Contract Recruiter, 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.

The opportunity:  

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. 

How you will contribute: 

• 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.  

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