Manager, Provider Operations (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: Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Our leaders are expected to foster connection and teamwork by being present in the office 2 to 3 days per week.

The opportunity: 
The Manager, Provider Operations plays a key leadership role in overseeing a team of credentialing, reporting and analysis specialists and drives the development of viable business solutions that result in measurable returns on investment. This incumbent oversees data reporting and evaluation, identifying and implementing process improvement and operational efficiency opportunities, coordinating and conducting new system functionality, user acceptance testing and operational readiness for technology solutions. Responsibilities of the supervisor and team span the technology project life cycle, ensuring that the development of technical solutions incorporate continuous business improvement practices.

How you will contribute: 

• Oversee enrollment and credentialing of Providers in accordance with requirements (NCQA, CMS, etc.).
• Ensure credentialing process meets client expectations and state regulations.
• Assist with delegated credentialing audits as needed.
• Ensure all Applications and Site Reviews are tracked.
• Ensure reports are prepared accurately, timely and work to automate the reports where applicable.
• Allocate resources appropriately to meet deadlines.
• Ensure adequate coverage of site reviewers where required.
• Participate in the selection and implementation of corrective action plans.
• Provide recommended solutions to credentialing issues and changes in requirements.
• Assist in resolving complaints and issues with providers.
• Aid in answering Request for Proposal (RFP) questions.
• Provide consultative services to proactively meet customer needs, using management reports and trend analysis.
• Organize workflow between other departments to ensure efficient and accurate outcomes.
• 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.
• Assist in preparation of performance and wage evaluations in accordance to company policy.
• Approves attendance and time off for team members.
• Participate in the selection and implementation of Performance Improvement Plans and performance management initiatives.
• Create efficiencies with the department.
• Update management team as appropriate on major issues, both internal and external.
• Collaborate with business partners to evaluate business processes and workflows and assist in evaluating proposed technical solutions & process changes to ensure alignment with business initiatives
• Act as a change agent for business function by driving standards, procedures and process improvements to address business issues
• Provide dashboards and summary data outlining opportunities and impact of improvements
• Spearhead large provider data projects as subject matter expert
•  Use troubleshooting skills to identify, research and propose solutions to problems and accommodate necessary changes or corrective action, as needed
• Assess current processes, identify defects & areas of improvement and design future process models
• Aid direction setting for business requirements and process modeling methodologies
• Act as change agent internally and externally to gain alliance and prepare organization for new solutions
• Exhibit strong knowledge of business protocols and recommend