DentaQuest
Provider Network Intelligence Analyst, DentaQuest
DentaQuest, Hartford, Connecticut, United States
Overview
Provider Network Intelligence Analyst, DentaQuest role at DentaQuest. Sun Life U.S. is a large benefits provider working with employers, partners and government programs. DentaQuest manages dental and vision benefits for more than 33 million Americans with a focus on prevention and accessible quality care. 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 analyses based on claims, provider, member, group and related data to derive new knowledge from DentaQuest’s operational, financial and clinical databases. Organizes and supports 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. Works with other areas of the company, including Underwriting, Clinical Management and Client & Provider Engagement to help understand program cost and network trends and to recommend strategies for improvement where possible. How you will contribute
Responsible for tactical and strategic partnership with the CPE team in identifying, interpreting, prioritizing, designing and procuring analyses to guide business decisions. Partner with business and clinical teams and other internal clients to enable and execute impactful, accurate business analytics. Develop and maintain deep understanding of financial performance metrics with an eye toward identifying opportunities 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 network expansion requirements. Maintain 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 consistent with quality, cost-effective care. Collaborate with internal departments to develop strategies and programs to manage dental costs within each market to assure profitability and budgetary goals. Provide support to internal business partners to increase understanding of cost analysis and empower independent assessments. Utilize Microsoft Office products to prepare client-friendly materials that comprehensively represent cost data. Provide recommendations on policies, objectives and initiatives; evaluate and suggest changes as necessary to optimize processes and efficiencies. Participate in special projects as needed; analyze leased network data and partnership network data; evaluate provider fee data (e.g., net effective discount, Fair Health data) by product (Medicare Advantage, Exchange, D2C, EPO, PPO). Collect data for use in RFP data/Bid data analysis and prep; other duties as needed or required. What you will bring with you
Required: Bachelor’s degree in Computer Science, Math, Finance or business-related field or equivalent experience. 3 years’ experience in complex data management, analysis and reporting to include experience with combining clinical and financial data. Demonstrated project and client management expertise. Ability to present complex analytic methodology, interpretation and recommendations to diverse senior-level audiences through visual, verbal and written deliverables. Ability to identify appropriate analytic approaches to solve broad business challenges. Experience with database and business intelligence tools. Strong experience in statistical methods and concepts required. Demonstrated ability to analyze, solve and interpret complex problems. Knowledge of provider reimbursement methodologies. Excellent PC skills with proficiency in MS Office products (Excel, Access, Word, PowerPoint). Strong customer service and analytical skills; strong project management and process improvement skills. Ability to lead and work well with others; ability to prioritize and organize multiple tasks and meet deadlines. Comprehensive understanding of business management, research and/or economics. Preferred Qualifications: Knowledge of health care industry. Salary
Salary Range: $67,300 - $101,000. Noting pay transparency and equity; actual base salary determined by skills, qualifications, experience, education, and geographic location. Eligible for a discretionary annual incentive based on individual and business performance. We are committed to an inclusive environment and encourage applications from qualified individuals from all backgrounds. We provide comprehensive benefits and a flexible, collaborative work environment. Equal Opportunity
Sun Life will consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable laws. 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. Job Category: Business Analysis - Systems Posting End Date: 30/10/2025
#J-18808-Ljbffr
Provider Network Intelligence Analyst, DentaQuest role at DentaQuest. Sun Life U.S. is a large benefits provider working with employers, partners and government programs. DentaQuest manages dental and vision benefits for more than 33 million Americans with a focus on prevention and accessible quality care. 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 analyses based on claims, provider, member, group and related data to derive new knowledge from DentaQuest’s operational, financial and clinical databases. Organizes and supports 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. Works with other areas of the company, including Underwriting, Clinical Management and Client & Provider Engagement to help understand program cost and network trends and to recommend strategies for improvement where possible. How you will contribute
Responsible for tactical and strategic partnership with the CPE team in identifying, interpreting, prioritizing, designing and procuring analyses to guide business decisions. Partner with business and clinical teams and other internal clients to enable and execute impactful, accurate business analytics. Develop and maintain deep understanding of financial performance metrics with an eye toward identifying opportunities 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 network expansion requirements. Maintain 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 consistent with quality, cost-effective care. Collaborate with internal departments to develop strategies and programs to manage dental costs within each market to assure profitability and budgetary goals. Provide support to internal business partners to increase understanding of cost analysis and empower independent assessments. Utilize Microsoft Office products to prepare client-friendly materials that comprehensively represent cost data. Provide recommendations on policies, objectives and initiatives; evaluate and suggest changes as necessary to optimize processes and efficiencies. Participate in special projects as needed; analyze leased network data and partnership network data; evaluate provider fee data (e.g., net effective discount, Fair Health data) by product (Medicare Advantage, Exchange, D2C, EPO, PPO). Collect data for use in RFP data/Bid data analysis and prep; other duties as needed or required. What you will bring with you
Required: Bachelor’s degree in Computer Science, Math, Finance or business-related field or equivalent experience. 3 years’ experience in complex data management, analysis and reporting to include experience with combining clinical and financial data. Demonstrated project and client management expertise. Ability to present complex analytic methodology, interpretation and recommendations to diverse senior-level audiences through visual, verbal and written deliverables. Ability to identify appropriate analytic approaches to solve broad business challenges. Experience with database and business intelligence tools. Strong experience in statistical methods and concepts required. Demonstrated ability to analyze, solve and interpret complex problems. Knowledge of provider reimbursement methodologies. Excellent PC skills with proficiency in MS Office products (Excel, Access, Word, PowerPoint). Strong customer service and analytical skills; strong project management and process improvement skills. Ability to lead and work well with others; ability to prioritize and organize multiple tasks and meet deadlines. Comprehensive understanding of business management, research and/or economics. Preferred Qualifications: Knowledge of health care industry. Salary
Salary Range: $67,300 - $101,000. Noting pay transparency and equity; actual base salary determined by skills, qualifications, experience, education, and geographic location. Eligible for a discretionary annual incentive based on individual and business performance. We are committed to an inclusive environment and encourage applications from qualified individuals from all backgrounds. We provide comprehensive benefits and a flexible, collaborative work environment. Equal Opportunity
Sun Life will consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable laws. 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. Job Category: Business Analysis - Systems Posting End Date: 30/10/2025
#J-18808-Ljbffr