Sr. Manager, Provider Engagement, 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.

** Individuals ideally would be located within the midwest or east region, as they will need to travel to meet clients and their staff within the states of their territory.

The opportunity:  

 The Provider Engagement Sr. Manager is the primary point person for providers to improve their understanding of our benefit programs, policies and procedures. This position is responsible for provider networks regarding office education, technology promotion, network recruitment (expansion and strengthening utilization), and general on boarding of newly contracted providers. In addition, this role administers on-site office reviews as required by network rules and regulations.

How you will contribute:  

• Maintain network participation by providing support to dentists and dental office managers to improve their understanding of all available benefit programs.

• Educate providers by instructing 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.

• Recruit non-participating providers within cost and access goals.

• Negotiate special deals to maintain compliance and increase access in networks.

• Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.

• Vendor relationship management for provider-facing technologies.

• Facilitate Oral Health presentations to various educational institutions and organizations.

• Assist provider offices in filing their claims electronically.

• Serve as a liaison with dental offices by answering remittance, payment, benefit, claims, and eligibility questions when necessary.

• Follow up with all termination letters submitted.

• Represent clients and company at health fairs, audits, dental summits, etc. throughout your designated market.

• Maintain and submit all required reports. Netminder management

• Assist in resolving elevated complaints and issues for clients, members and providers.

• Provider electronic file maintenance.

• Coordinate and implement appropriate performance management strategies for team members to include:

• Assist in the hiring process, including interviewing candidates

• Assist, train and motivate team members

• Evaluate and measure effectiveness of team members

• Assist in preparation of performance and wage evaluations in accordance to company policy

• Responsible for attendance and company approved time off for team members

• Participate in the determination and implementation of Performance Improvement Plans and performance management initiatives

• Other duties as assigned

 What you will bring with you:  

• 5 years’ experience in healthcare practice or managed care environment.

• 3 years’ supervisory