Maryland Provider Partner Consultant, DentaQuest

Overview

Maryland Provider Partner Consultant, DentaQuest. Candidates must reside in the state of Maryland. Preferably Garrett, Allegany, Washington, Frederick, Calvert, St. Mary's, Charles, or Eastern Shore counties.

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

Job Description : The Provider Partner is the primary on-site point person for providers to improve their understanding of our benefit programs, policies and procedures. The Provider Partner is responsible for provider networks with regard to office education, technology promotion, network recruitment (expansion and strengthening utilization), and onboarding of newly contracted providers. The Provider Partner also administers on-site office reviews as required by network rules and regulations.

Responsibilities

• Analyze and monitor provider cost reports to educate and improve providers’ cost and quality performance.
• Maintain network participation by providing support to dentists and dental office managers to improve understanding of all available benefit programs.
• Educate providers on comprehensive policies and procedures involving all phases of the corporation’s benefits and contracts through office visits and phone / email communication.
• Promote dentist adoption of technology solutions by promoting Web applications and increasing the volume of electronic claims.
• Negotiate special deals to maintain compliance and increase access in weak networks.
• Recommend changes in internal methods and procedures to Quality Assurance processes.
• Facilitate oral health presentations to educational institutions and organizations.
• Assist provider offices in filing their claims electronically.
• Answer remittance, payment, benefit, claims, and eligibility questions as a partner with dental offices when necessary.
• Follow up with all termination letters submitted.
• Represent clients and company at trade shows, health fairs, audits, dental summits, etc. in the 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 understanding of the Office Reference Manuals and personalize presentations of company benefit programs.
• Recruit participating and non-participating providers to a higher level of participation for all applicable market lines of business.
• Manage CAP office performance and provide recommended solutions to market-related issues.
• Organize and present information to providers and staff by speaking before provider organizations and representing the company in dental-related activities.
• Assist in problem resolution by identifying improvements, evaluating feasibility of programs and presenting recommendations.
• Develop and implement approaches to improve the quality of information exchanged between the company and dental offices.
• Resolve difficult claims issues in a timely manner with internal resources.
• Increase access for members by strengthening and expanding the network; maintain a secondary network.
• Other duties as assigned.

Qualifications

What you will bring with you :

Preferred :

Salary

Salary Range : $63,000 - $94,500

We are committed to pay transparency and equity. Your actual base salary will be determined based on your skills, qualifications, experience, education, and geographic location. This position is eligible for a discretionary annual incentive award based on performance. We are dedicated to a work environment where everyone is rewarded for their contributions.

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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 encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize well-being with comprehensive benefits, including vacation and sick time, parental leave, medical coverage, company paid life and disability insurance, and retirement plan options. We support career growth and a flexible, inclusive environment. We are a recognized employer and value diversity. For accommodation requests, please email thebrightside@sunlife.com.

For applicants residing in California, please read our employee California Privacy Policy and Notice. We do not require lie detector tests. Sun Life will consider all qualified applicants, including those with criminal histories, in accordance with applicable laws. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Job Category : Sales - Client Relationship Management

Posting End Date : 30 / 10 / 2025

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