Provider Partner Consultant, DentaQuest (Kansas City, Missouri) )
Job description
You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.
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 be located in Kansas City, Missouri**
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: Provider Partner has a special focus on managing the program. This includes internal and external training and communications, member assignments, outreach, provider payment, monitoring systems and reporting needed for effective management of the dental home program, including financial effectiveness.
- Manage optimization of network partnerships including program implementation, promotion of dental home management principles and process improvement.
- Manage, analyze, select and maintain network of participating providers.
- Work with underwriting to achieve loss ratio goals through effective member assignment, monitoring and management of services rendered and addressing non performing providers.
- Manage financial results of the dental home program including loss ratio and administrative expenses.
- Design reports to effectively manage member assignment, performance of provider offices and achieving access goals.
- Develop and implement innovative approaches to improve the quality of information exchanged between DentaQuest and dental offices.
- Assist with member management, ensuring the right member gets the right treatment and the right place and right time.
- Assist in problem resolution by identifying improvement opportunities, evaluating feasibility of programs and presenting recommendations.
- Creation of dental home materials including marketing, training, reports, policies and procedures.
- Assist with designing the web portal as an effective method of educating providers and posting marketing documents and reports for providers.
- Educate providers on the dental home concept.
- Educate internal team members and external stakeholders and clients on the dental home concept.
- Assist with collaborating with and educating physicians and their role in working with dentists and DentaQuest.
- Adhere to DentaQuest business processes.
- Other duties as needed or required.
What you will bring with you :
- Bachelor’s degree or equivalent experience.
- Dental or medical insurance knowledge with 5 years of experience.
- Knowledge of dental home, medical home, care management or case management.
- Knowledge of regulatory and reimbursement strategies.
- Excellent analytical skills and ability to understand and interpret complex data/reports.
- Financial acumen and ability to understand financial statements, loss ratio and provider reimbursement.
- Excellent verbal, presentation and written communication skills.
- Strong leadership skills related to team and project assignments working across multiple departments.
- Ability to work independently and as part of a team at a leadership level.
- Knowledge of Microsoft Office.
- Proven problem-solving skills.
- Valid driver’s license required.
- Attends additional training as requested/deemed necessary.
Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.
Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!
Life is brighter when you work at Sun Life
Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more
Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account
A flexible work environment with a friendly, caring, collaborative and inclusive culture
Great Place to Work® Certified in Canada and the U.S.
Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.
Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
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Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email recruitingUS@sunlife.com to request an accommodation.
At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran
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