Dental Director, California Market, DentaQuest

Sun Life • Irvine, CA

323d • $126,700 - $190,100

About The Position

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: The Dental Advisor 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 act as a clinical SME (or liaison) for internal entities.

Requirements

• Graduate of an accredited Dental School (D.D.S. or D.M.D)
• Maintain an unrestricted dental license
• Knowledge of general dentistry
• Orthodontic 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

Nice To Haves

• 5 years of clinical experience desirable

Responsibilities

• Facilitate provider orientations.
• 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 education 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree