Provider Partner Consultant; Iowa

Overview

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access care and coverage. 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.

Sun Life U.S. is committed to fostering an inclusive environment where all employees feel they belong and are supported to thrive.

For more information, visit our website to learn how Sun Life is making life brighter for customers, partners and communities.

The Provider Partner Consultant handles developing and managing relationships with providers within their assigned market. This role spends time communicating with providers about the suite of benefit programs (Medicaid, Medicare Advantage, Marketplace, Direct to Consumer, Commercial and any blend of dental products) to aid DLR in risk markets and the P&L of the network. The Provider Partner Consultant works collaboratively with reporting to discern provider reports and promote continuous improvement for top providers (high performance metrics, cost, outliers, quality, etc.).

• Maintain visibility within their market, with an eye toward managing their network across all product lines.
• Evaluate and monitor provider cost reports on an ongoing basis to educate and improve providers’ cost and quality performance.
• Recruit new providers and maintain network participation by aiding dentists and dental office managers to improve awareness of all available benefit programs.
• Educate providers and serve as the primary point of contact for instruction and advising of comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and communication via phone and email.
• Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.
• Seek continuous improvements by recommending changes in internal methods and procedures to Quality Assurance process.
• Facilitate oral health presentations to educational institutions and organizations.
• Represent clients and the company at trade shows, health fairs, audits, dental summits, etc. in the designated market and/or state.
• Govern creation and submission of all required reports.
• Act as a subject matter expert for their geographic area.
• Develop a complete grasp of the Office Reference Manuals for implementation within their region.
• Develop and continually improve personalized presentations of company benefit programs.
• Provide recommended solutions to market-related issues.
• Measure impact of provider satisfaction and respond to provider issues.
• Organize and present information to providers and their staff by speaking before 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.
• Perform in-depth investigation of fee schedules, including fee schedule comparisons, to negotiate competitive custom fee schedules where needed.
• Provide regular updates to senior management on internal and external issues affecting network market performance.
• Develop and implement processes to improve overall client and provider satisfaction.
• Develop and maintain relationships with appropriate functional areas to ensure effective contract performance.
• Aid innovative business practices and process improvement opportunities for current and prospective clients.
• Maintain a secondary network to ensure access to care for all eligible members.
• Other duties as assigned.

• Dental knowledge with five (5) or more years of office experience.
• Managed Care experience
• Strong presentation skills
• Excellent verbal and written communication skills
• Ability to work independently and as part of a team
• Knowledge…