AVP, Member & Provider Service Delivery

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.

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 Opportunity:

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.

What you will do:

Operational Leadership & Strategy

• 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.

Client Setup Configuration & Workflow Enablement

• 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.

Member Enrollment & Eligibility Operations

• 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.

Correspondence Operations (Member/Provider/Client)

• 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.

Provider Credentialing & Provider Operations

• 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.

Quality Compliance Risk & Controls

• 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.

Performance Management Analytics & Continuous Improvement

• 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.

Stakeholder Management & Cross-Functional Partnership

• 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.

People Leadership

• 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.

What you will bring with you:

• Bachelors degree required; Masters 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.

Preferred Qualifications

• 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.

Core Competencies

• Executive operational leadership; strong judgment under ambiguity
• Change management and transformation leadership
• Analytical rigor; KPI design and performance storytelling
• Process governance and risk management
• Client-centric mindset; escalation leadership
• Talent development and culture building
• Cross-functional influence with Product/IT/Compliance/Network/Claims

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 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. National Salary Range: 00

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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.

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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.