Dental Director, California Market, DentaQuest

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.

Job Description :

Location : Candidate must be located in the state of California.

At Sun Life, we look for optimistic people who want to make life brighter for ourClients.We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work.Every day,you'll be empowered and challengedbyworking withdynamic colleaguesto find new and innovative ways to make Sun Life the best benefits company in America.

The opportunity :

The Dental Advisor reviews claims based on medical necessity, in accordance with market contracts, evaluate appeals, counsel providers, identify providers with aberrant utilization patterns, provide clinical support for provider outreach, and act as a clinical SME (or liaison) for internal entities.

How you will contribute :

Facilitate provider orientations.

Represent DentaQuest in a professional manner at all times when interacting with clients, management, employees, the provider community, dental associates, and other key stakeholders.

Adhere to all DentaQuest policies, processes and procedures.

Identify and recommend process and productivity improvement opportunities.

Establish and maintain an understanding of dental program administration , including, but not limited to : benefit and authorization requirements for plans and / or states, claims payment and the denial process, and a business understanding of ASO and Risk relationships

Develop a strong knowledge base and overall understanding of state and federal dental regulations.

Proactively alert DentaQuest staff of potential state regulatory changes impacting dental benefits / administration.

Act as a DentaQuest liaison to the provider community, offering educations sessions associated with our dental programs.

Proactively identify and participate in activities, programs, and speaking engagements associated with Medicaid and Medicare Dental Programs

Identify and recommend regional community related activities and events (e.g. Health Fairs, Dental Screenings, Back to School Programs, etc.) DentaQuest can participate in to further our mission.

Establish and maintain an understanding of DentaQuest's Oral Health Wellness and Outreach Programs.

Review dental cases and represent DentaQuest at fair hearings, as needed or directed.

Establish and maintain strategic relationships with regional dental associations and key stakeholders for the purpose of solidifying new business and / or maintaining existing business.

Recruit qualified providers for DentaQuest networks as needed or directed.

Perform other duties as assigned

What you will bring with you :

Graduate of an accredited Dental School (D.D.S. or D.M.D)

Maintain an unrestricted dental license

Knowledge of general dentistry

Orthodontic experience a plus

Efficient PC skills

Ability to use analytical / presentation tools such as Excel and PowerPoint.

Organizational and time management skills

Ability to work with a team and independently to complete assigned tasks without supervision

Ability to make independent determinations on all types of dental claims

Excellent written and verbal communication skills

Ability to distinguish between multiple market benefits

Ability to prioritize and organize multiple tasks

Ability to remain organized with multiple interruptions

Networking and Negotiation skills required

Ability to travel as needed

Required to attend additional training as requested / deemed necessary

Preferred :

5 years of clinical experience desirable

Do you see yourself in this role even if you haven't checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you.

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!

Life is brighter when you work at Sun Life

Excellent benefits and wellness programs to support the three pillars of your well-being - mental, physical and financial - including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more

Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account

A flexible work environment with a friendly, caring, collaborative and inclusive culture

Great Place to Work Certified in Canada and the U.S.

Named as a "Top 10" employer by the Boston Globe's "Top Places to Work" two years running

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.

Salary Range : $126,700 - $190,100

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, qualifications, 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.

Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com / us to learn more.

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.

LI-remote

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 thebrightside@sunlife.comto 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.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

Job Category : Medical Services

Posting End Date : 27 / 02 / 2025

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 vetera n

Salary : $126,700 - $190,100