Provider Relations Representative, Dentaquest (Laguna Hills, Ca)

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

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.

**Candidate must reside in Laguna Hills, CA or within a commutable distance for this hybrid role.

Provider Relations Representative

We are seeking a motivated and personable individual to join our team as a Dental Provider Relations Representative. In this role, you will be responsible for establishing and maintaining positive relationships with dental providers, ensuring effective communication and collaboration. Your primary goal will be to enhance the quality of our dental network, foster partnerships, and contribute to the overall success of our dental programs.

Preferred skills

• Strong negotiation and contract management skills.
• Excellent interpersonal and communication skills, both written and verbal.
• Ability to work independently and collaboratively within a team environment.
• Proficient in Microsoft Office Suite and CRM software.

Qualifications

• Previous experience in Provider Relations, network development, or a similar role within the healthcare or dental industry.
• Knowledge of dental industry regulations, reimbursement processes, and managed care principles.

Responsibilities

• Develop and maintain Provider Relationships and serve as a primary resource for information between the plan and provider network.
• Investigate and resolve issues between the plan and provider network through monthly and quarterly provider outreach.
• Dutifully ensure open lines of communication between the plan and provider network to address concerns, answer questions, and apprise offices of quality care metrics.
• Ensure providers receive timely and accurate information regarding organization initiatives, services, programs, policies and procedures, and quality and productivity measurements.
• Provide supervisor(s) with updates on assigned provider network per their request.
• Respond to incoming phone calls and emails promptly.
• Verify monthly provider effective dates, termination dates, open/closed panel status, demographic information, and health plan identification numbers.
• Communicate and interact effectively with internal and external entities.
• Play an active role in achieving PR Department goals. Assist assigned provider network in improving quality and business processes.
• Share improvement ideas with your PR supervisor/s and PR Department.
• Assist with marketing the company by attending and participating in group events.
• Coordinate, participate, and attend providers programs sponsored by company.
• Review and report statistical data for potential chart review / audit of participating provider network.
• Maintain and provide feedback on structured process for quality of audits, tracking and trending of provider metrics.
• Encourage provider network to increase membership and active participation.
• Identify and recruit new dental providers to expand the network and meet organizational goals.
• Utilize data and analytics to assess provider performance, identify trends, and implement strategies to improve network efficiency.
• Work on special projects as assigned by supervisor(s) or company leadership. Work collaboratively and constructively with all departments.
• Complete other duties as assigned.

The salary range for this position is $46,300 - 62,500.

Our Affirmative Action Program affirms our commitment to make reasonable accommodation to the known physical or mental limitation 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 recruitingUS@sunlife.com to request an accommodation.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

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