Provider Network Intelligence Analyst, DentaQuest Position Available In Cumberland, Maine

Provider Network Intelligence Analyst, DentaQuest at Sun Life Financial (U.S.) Services Company, Inc. in South Portland, Maine, United States Job Description Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide. Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities. 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:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work.

The opportunity:

Responsible for developing tactical and strategic recommendations for optimization of profitability, clinical performance, member and provider satisfaction and client satisfaction by leveraging analytic tools, financial models and reports. Conducts and manages procurement of analysis based on claims, provider, member, group and related data to derive new knowledge from DentaQuest’s operational, financial and clinical databases. Will organize, support efforts to measure, analyze and report on trends enterprise-wide related to utilization, reimbursements, access to care, cost management, and other high-level metrics to identify and promote strategies to positively influence access to quality, cost and improved program performance. This position will also work with other areas of the company, including Underwriting, Clinical Management and Client & Provider Engagement to assist in the understanding of program cost and network trends impacting profitability and to recommend strategies for improvement wherever possible.

How you will contribute:

Responsible for tactical and strategic partnership with the CPE team in identifying, interpreting, prioritizing, designing and procuring analyses to help guide business decisions. Responsible for partnering with business and clinical teams and other internal clients and resources to enable and execute impactful, accurate business analytics. Develop and maintain deep understanding of financial performance metrics with an eye toward identifying and addressing areas of opportunity or risk. Create, generate and maintain reports related to network composition and/or expansion through MS-Excel, MS-Access, SQL, SAS, Power BI and Quest Analytics. Populate and analyze operational reports as needed for filling RFP, RFR, and/or any network expansion requirements. Maintains current knowledge of DentaQuest benefits, provider reimbursement methodologies, provider contracts, State regulations, claims adjudication and other party liability procedures. Responsible for the structure, design, and integrity of all data within Network Development Provider and Reimbursement database. Develop a strong understanding of analytical tools and models to provide analysis of client and provider data. Lead analytical projects and coordinate with other team members, including programmers to deliver on internal client needs. Analyze current cost management practices and help to define best practices for: Outcome measurement Provider optimization Benefit structures and algorithms System edits, outlier trends, UM and UR Member behavior management Monitor and track provider reimbursements to identify strategies to ensure access and profitability targets are met in a manner that is consistent with quality, cost effective care. Work with other internal departments as necessary to develop strategies and programs to manage… For full info follow application link. Sun Life Financial is an equal employment and affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, religion, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, ancestry or citizenship status, genetic information, pregnancy status or any other characteristic protected by law. Sun Life Financial is committed to building a diverse and inclusive company culture. 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.