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.

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 unique solutions to complex provider credentialing and payment scenarios
• Assign team members to approved initiatives and projects while ensuring clear knowledge of roles and scope to aid the development of business process and technical solutions
• Manage staffing requirements within the team to ensure that resources are consistent with need and adequate to meet the enterprise's strategic objectives and approved project portfolio
• Work with the business partners to ensure that anticipated business value is achieved
• Effectively communicate with IT and business partners, as well as vendors, consultants and auditors
• Apply critical thinking to identify opportunities for operational process improvement and increased system use efficiency, as well as, advise as to how to resolve problems and avoid issues through enhancements or workaround options where applicable
• Collect and evaluate data to report department results, resolve critical business problems and identify trends for improvement
• Ensure completion of timely and accurate client reporting
• Other duties as needed or required.

What you will bring with you:

• Bachelor's Degree or equivalent experience
• 3 years of supervisory experience required.
• Requires 5 years of experience in business analysis, requirements definition and testing
• Experience directing and mentoring testing professionals within an agile development framework
• Strong Project management and process improvement skills.
• Solid working experience using MSOffice tools such as project manager, Visio and SQL query
• Excellent data analytics and problem solving skills
• Excellent communication skills - written, verbal, and presentation
• Strong business acumen
• Ability to prioritize and organize multiple tasks and manage multiple priorities
• Ability to make appropriate judgements within tight timeframes
• Ability to work well with others at all levels of the organization
• Ability to prioritize and manage multiple objectives while adapting to changing conditions
• Required to attend additional training as requested/deemed necessary

Salary:$58,700 - 88,100

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, qualification, 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.comto 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.