AVP, Member & Provider Service Delivery

Sun Life•Wellesley, MA

22h•$148,100 - $237,000•Remote

About The Position

The AVP, Member & Provider Service Delivery is accountable for end-to-end operational performance across client configuration and setup, workflow configuration, member enrollment, outbound correspondence, provider credentialing, and provider operations for a large, complex dental benefits administrator. This leader ensures that operational processes, controls, and systems configuration support accurate plan administration, exceptional client/member/provider experience, regulatory compliance, and scalable growth. This role owns strategy and execution for operational readiness and ongoing performance, partnering closely with Client Implementation, Product, IT, Compliance, Claims, Network Management, and Client Engagement to deliver consistent, reliable, and auditable outcomes.

Requirements

Bachelor’s degree required; Master’s degree preferred (Business Admin, Analytics, Healthcare Admin).
10+ years progressive operations leadership experience within dental/health benefits administration, payer operations, or complex healthcare services.
5+ years leading multi-team or multi-function operations (managers-of-managers strongly preferred).
Demonstrated expertise in: Benefits configuration / plan setup in core administration platforms Enrollment/eligibility operations and reconciliation Provider credentialing and provider lifecycle operations Operational controls, audit readiness, and process governance
Strong ability to translate policy/product requirements into operational execution and system configuration.

Nice To Haves

Experience supporting large, complex book-of-business (multi-state, ASO, public sector, Taft-Hartley, multi-product).
Familiarity with operational components such as EDI eligibility feeds (e.g., 834), provider data management, directory requirements, and correspondence template governance.
Lean Six Sigma (Green Belt/Black Belt) or similar process improvement certification.
Experience leading operations transformation, automation, or core system modernization.

Responsibilities

Provide strategic and day-to-day leadership across configuration, enrollment, correspondence, provider credentialing, and provider operations.
Establish a high-performing culture focused on quality, productivity, continuous improvement, and client/member/provider experience.
Drive operational scale and standardization while enabling flexibility for complex benefit designs and client requirements.
Develop and manage annual operating plans, staffing models, budgets, and capacity planning aligned to growth forecasts and client commitments.
Own operational execution for new client builds, renewals, and mid-year changes, including: Benefit plan configuration (plan rules, limitations, frequencies, accumulators, eligibility rules, COB/coordination rules, exclusions) Group structure and product setup Workflow configuration and routing for operations teams and downstream processes
Implement governance for configuration change management, including intake, requirements validation, testing coordination, and production release controls.
Ensure configuration accuracy through robust validation, peer review, and audit-ready documentation.
Lead eligibility and enrollment operations (intake, reconciliation, error resolution, retroactivity, dependent rules, termination/reinstatement).
Partner with EDI/Integration teams to stabilize file processing, improve acceptance rates, and reduce manual work.
Establish SLAs for enrollment timeliness and accuracy, ensuring member experience, claims readiness, and billing alignment.
Drive exception management and root-cause elimination with clients, brokers, and internal stakeholders.
Oversee creation and configuration of outbound correspondence (letters/notices), including templates, triggers, approval workflows, and distribution channels (print, digital).
Ensure correspondence complies with regulatory, contractual, and brand standards; maintain version control and audit trails.
Improve turn-around time and accuracy; monitor vendor/print performance as applicable.
Lead end-to-end provider onboarding and lifecycle operations, including credentialing/recredentialing, directory updates, demographic maintenance, and status changes.
Ensure credentialing workflows meet internal policy, accreditation expectations, and regulatory/contractual requirements.
Improve provider experience and reduce onboarding cycle times while maintaining quality and compliance.
Partner with Network, Contracting, and Provider Relations to align operational outcomes to network adequacy and growth goals.
Establish and maintain SOPs, controls, and documentation required for audits, regulatory requirements, and client commitments.
Own operational risk management including error remediation, trend monitoring, corrective action plans, and reporting.
Ensure strong data stewardship and privacy controls, collaborating with Compliance, Security, and Legal.
Maintain business continuity plans and cross-training strategies to ensure service resilience.
Define and track KPIs/OKRs across all functions (accuracy, cycle time, backlog, cost per transaction, first-pass yield, provider onboarding time, enrollment reconciliation rates).
Use Lean/Six Sigma / continuous improvement methods to reduce defects and rework, eliminate waste, and automate manual activities.
Drive modernization through workflow tooling, RPA/automation, and standardized configuration patterns.
Lead cross-functional issue resolution for systemic defects affecting claims, eligibility, provider status, or correspondence.
Serve as the operational executive interface for major implementations, high-impact changes, and escalations.
Partner with Product/IT to translate operational needs into system enhancements, prioritize backlogs, and improve usability.
Collaborate with Client Services/Account Management on operational readiness and service delivery performance.
Present operational performance, risks, and recommendations to senior leadership and key clients as needed.
Lead multiple managers and cross-functional teams (potentially including configuration analysts, enrollment specialists, correspondence analysts, credentialing teams, and provider ops staff).
Set clear performance expectations and career pathways, coach leaders on talent development, engagement, and accountability.
Build workforce plans that support peak volumes, implementation waves, and regulatory change cycles.