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:
Job Description
$ads={1}
This position directs and manages a broad suite of Operations functions administering benefits for a large market. Together with the VP of Operations, the AVP of Operations is accountable for the collective achievement of superior operational performance of 250 employees in a singular line of business. The AVP is directly responsible for positive performance and financial outcomes across utilization management, customer service, claim processing, provider data and credentialing, complaints, grievances and appeals and client engagement. The AVP will focus on building strong communication channels between the operational teams and the client, groups, and brokers.Qualifications
- Bachelor’s Degree required
- Technology acumen required
- Prior experience in healthcare operations
- Prior experience in client relations management
- Excellent data analytics and problem-solving skills
- Knowledge of business projects and concepts through direct assistance and management
- Ability to present and interact with clients regarding all operational aspects of DentaQuest
- Self-managed in an autonomous environment
- Ability to manage project resources that do not have a direct reporting relationship
- Demonstrated ability to manage high volume transactions in a production environment
- Proven business acumen
- Ability to prioritize and organize multiple tasks and manage competing priorities
- Excellent communication skills written, verbal and interpersonal
- Ability to work well with others at all levels of the organization
- Ability to manage multiple priorities and adapt to changing conditions
- Demonstrated achievements in project management leadership
- Strong presentation skills
- Ability to actively participates in the development and implementation of corporate strategic plans and focusing on their tactical implementation
- Ability to travel, when necessary
Responsibilities
- Provide leadership and oversight, ensuring the establishment of best practices and management of operations to achieve targeted budgets and metrics
- Define and establish departmental strategies and long-range goals
- Ensure company compliance with contract service levels and regulatory guidelines and requirements
- Perform as a data-driven leader exceling at evaluating performance gaps and process inefficiencies, driving results through a highly skilled leadership team, and implementing workflow and technology solutions that meet contractual and regulatory requirements and exceed client SLAs
- Lead management team that performs organizational quality & process analysis; developing & executing plans to improve operational accuracy, compliance & efficiency
- Monitor and implement business quality controls to include measurements, metrics, and improvement opportunities for functions
- Develop and implement strategic business plans that meet or exceed enterprise goals and objectives
- Monitor the performance of sub-delegated outsourced functions, manage the partnerships, and evaluate vendors’ performance for continued alignment with operational priorities
- Provide leadership and oversight, ensuring the establishment of best practices and management of operations to achieve targeted budgets and metrics
- Define and establish departmental strategies and long-range goals
- Ensure company compliance with contract service levels and regulatory guidelines and requirements
- Manage and direct the strategic and tactical operations for clinical predeterminations and claim processing, provider credentialing and data management, complaints grievances and appeals and customer service
- Partner with the Vice President, Operations to effectively implement change processes to operationalize the tactical direction of the business
- Participate in the development of corporate strategic plans and focus teams on their tactical implementation
- Responsibility for compliance of the program in accordance with applicable contractual and regulatory guidelines
- Motivate staff through effective management and delegation and by formulating and administering policies
- Direct departmental activities to achieve goals that meet business and profitability growth objectives
- Maintain positive and professional relationships with key account clients
- Monitor turnaround times, call statistics, and quality of department functions essential to meeting or exceeding contractual obligations
- Recognize and promote diversity in all aspects of resource management
- Other duties as assigned
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.
For applicants residing in California, please read our employee California Privacy Policy and Notice.
Job Category:
Posting End Date:
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
