Provider Partner Consultant South Carolina
Provider Partner Consultant South Carolina
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Job 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 6400 employees and associates in our partner dental practices and operate nationwide.
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: Candidate must be located in the state of South Carolina.
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The opportunity:
This role should act as the primary on site point person for providers to improve their understanding of our benefit programs policies and procedures. Responsible for provider networks with regard to office education technology promotion network recruitment (expansion and strengthening utilization) and general on boarding of newly contracted providers. Administer on-site office reviews as required by network rules and regulations. This role does require travel up to 50% of the time.
How you will contribute:
Maintain network participation by providing support to dentists and dental office managers to improve their understanding of all available benefit programs.
Educate providers by instructing and advising of the comprehensive policies and procedures involving all phases of the corporations benefits and contracts through office visits and communication over the phone and email.
Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.
Recruit nonparticipating providers to join our networks.
Negotiate special deals to maintain compliance and increase access in weak networks.
Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.
Facilitate Oral Health presentations to various educational institutions and organizations.
Assist provider offices in filing their claims electronically.
Serve as a liaison with dental offices by answering remittance payment benefit claims and eligibility questions when necessary.
Follow up with all termination letters submitted.
Represent clients and company at health fairs audits dental summits etc throughout your designated market.
Maintain and submit all required reports.
Assist in resolving elevated complaints and issues for clients members and providers.
Obtain letters of recommendation from providers.
Develop complete understanding of the Office Reference Manuals.
Develop and continually improve personalized presentations of company benefit programs
Recruit participating and non-participating providers to higher levels of participation.
Provide recommended solutions to market related issues.
Organize and present information to providers and their staff by speaking before various provider organizations and representing the corporation in dental related activities.
Assist in problem resolution by identifying improvement opportunities evaluating feasibility of programs and presenting recommendations when appropriate.
Develop and implement approaches by working with dentists and their office staff to improve the quality of information exchanged between the company and dental offices.
Resolve difficult claims issues in a timely manner by working with the appropriate internal resources to research and resolve such issues.
Increase access for members by strengthening and expanding existing network.
Help to maintain a secondary network.
What you will bring with you:
Required:
Bachelors Degree or relevant experience
Strong presentation skills.
Excellent verbal and written communication skills.
Ability to work independently and as part of a team.
Knowledge of Microsoft Office.
Proven problem-solving skills.
Own transportation for office and site visits (10% - 50% travel required). Valid drivers license required.
Problem solving and training experience.
Ability to make good judgment conclusions based on data available with minimal supervision
Preferred:
Dental knowledge with five (5) or more years of office experience.
Managed Care Experience.
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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. Were proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S. weve also been recognized as a Top 10 employer by the Boston Globes 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 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.
Job Category:
Posting End Date:
Required Experience:
Contract
Employment Type
Full-Time
