Member Placement Representative, DentaQuest
This a Full Remote job, the offer is available from: United States
You are as unique as your background, experience and point of view. Here, youll 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: We support US flexible working arrangements in the contiguous 48 states.
At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, youll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.
The opportunity:
The Member Placement Representative will provide members with access to providers in the time frame mandated by the health plan. The Member Placement Representative will assist with provider network development including provider recruitment support.
How you will contribute:
Locate and negotiate rates with non-par providers for member placements.
Recruit non-participating providers to join our networks.
Serve as a direct contact for member placement issues from the health plan.
Negotiate special deals to maintain compliance and increase access in deficient networks.
Run required monthly and quarterly reports and sends to appropriate entities.
Maintain secondary provider placement spreadsheet for in-network providers.
Assist with administrative duties, provider surveys and departmental projects as assigned.
Communicate to management ways to improve processes and productivity of company.
Complete required documents for member placements.
Track and audit reimbursement to ensure proper payment is made.
Comprehend the language within Provider Agreements and Letters of Intent.
Process Specialty Referral requests in accordance with market placement guidelines.
Awareness of cost implications in each market when assigning specialty providers and one-time placements.
Maintain data on providers to ensure use of most efficient providers.
Other duties as assigned.
What you will bring with you:
High school diploma/GED
2 years relevant experience
Differentiate between allowable, Medicaid, and billed fees and reimbursement levels in each market.
Excellent verbal & written communication skills.
Ability to prioritize and organize multiple tasks.
Ability to remain organized with multiple interruptions.
Good PC Skills. Typing helpful.
Excellent analytical ability.
Required to attend additional training as requested/deemed necessary.
Do you see yourself in this role even if you havent 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 (https://pages.beamery.com/sunlifecareers/page/join-us-canada) 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.
If you are a California resident, the salary range for this position is:
Southern region: $43,900 - 59,600 annually
Northern region: $47,000 - 63,500 annually
If you are a Colorado or Nevada resident, the salary range for this position is $39,700 - 53,600 annually.
If you are a Connecticut or Maryland resident, the salary range for this position is $41,700 - 56,300 annually
If you are Washington or Rhode Island resident, the salary range for this position is $43,900 - 59,600 annually
If you are a New York resident, the salary range for this position is $47,000 - 63,500 annually
We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.
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.
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 [email protected] 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.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
Job Category:
Call Centre
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 veteran
This offer from "DentaQuest" has been enriched by Jobgether.com and got a 75% flex score.
Apply Now
You are as unique as your background, experience and point of view. Here, youll 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: We support US flexible working arrangements in the contiguous 48 states.
At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, youll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.
The opportunity:
The Member Placement Representative will provide members with access to providers in the time frame mandated by the health plan. The Member Placement Representative will assist with provider network development including provider recruitment support.
How you will contribute:
Locate and negotiate rates with non-par providers for member placements.
Recruit non-participating providers to join our networks.
Serve as a direct contact for member placement issues from the health plan.
Negotiate special deals to maintain compliance and increase access in deficient networks.
Run required monthly and quarterly reports and sends to appropriate entities.
Maintain secondary provider placement spreadsheet for in-network providers.
Assist with administrative duties, provider surveys and departmental projects as assigned.
Communicate to management ways to improve processes and productivity of company.
Complete required documents for member placements.
Track and audit reimbursement to ensure proper payment is made.
Comprehend the language within Provider Agreements and Letters of Intent.
Process Specialty Referral requests in accordance with market placement guidelines.
Awareness of cost implications in each market when assigning specialty providers and one-time placements.
Maintain data on providers to ensure use of most efficient providers.
Other duties as assigned.
What you will bring with you:
High school diploma/GED
2 years relevant experience
Differentiate between allowable, Medicaid, and billed fees and reimbursement levels in each market.
Excellent verbal & written communication skills.
Ability to prioritize and organize multiple tasks.
Ability to remain organized with multiple interruptions.
Good PC Skills. Typing helpful.
Excellent analytical ability.
Required to attend additional training as requested/deemed necessary.
Do you see yourself in this role even if you havent 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 (https://pages.beamery.com/sunlifecareers/page/join-us-canada) 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.
If you are a California resident, the salary range for this position is:
Southern region: $43,900 - 59,600 annually
Northern region: $47,000 - 63,500 annually
If you are a Colorado or Nevada resident, the salary range for this position is $39,700 - 53,600 annually.
If you are a Connecticut or Maryland resident, the salary range for this position is $41,700 - 56,300 annually
If you are Washington or Rhode Island resident, the salary range for this position is $43,900 - 59,600 annually
If you are a New York resident, the salary range for this position is $47,000 - 63,500 annually
We consider various factors in determining actual pay including your skills, qualifications, and experience. In addition to salary, this position is eligible for incentive awards based on individual and business performance as well as a broad range of competitive benefits.
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.
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 [email protected] 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.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
Job Category:
Call Centre
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 veteran
This offer from "DentaQuest" has been enriched by Jobgether.com and got a 75% flex score.
Apply Now