Description

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.

The Dental Director acts as a clinical subject matter expert for both internal entities and for the state of Missouri. 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 Missouri

• Physically reside in the state of Missouri

• At least 5 years of clinical experience preferred

Preferred:

• Knowledge of general dentistry

• Public health or pediatric 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

• Ability to remain organized with multiple interruptions

• Networking and Negotiation skills required

• Ability to travel as needed

• Required to attend additional training as requested/deemed necessary

Salary:  

Salary Range: $65,400-$98,100

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

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We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive.  We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate.  We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program.  Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account.  Enjoy a flexible, inclusive and collaborative work environment that supports career growth.  We're proud to be recognized in our communities as a top employer.  Proudly Great Place to Work® Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row.  Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations 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 thebrightside@sunlife.com to request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

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.