Manager Dental Benefits and Third-Party Payer Issues
HybridChicago, Illinois, United States
Job Summary
Manager for ADA Council on Dental Benefit Programs who leads operations of dental benefits and third-party payer initiatives, oversees program operations and policy development, and engages stakeholders. Provides staff support for public and professional volunteer committees and oversees the Third-Party Payer Concierge Service. This role includes a hybrid work schedule (2-3 days from home), travel for industry meetings, and collaboration across healthcare and dental benefits administration with external payers and provider networks. Responsible for driving operational leadership, program management, and cross-organizational engagement to optimize dental benefits administration within a nonprofit association environment.
Required Qualifications
- Bachelor's degree or experience in lieu of degree
- 5 years of experience (or 9 years in lieu of a degree) in the dental industry
- 3 years of program management or operations
- Experience engaging with external organizations or payers to resolve issues
- Experience in healthcare, managed care, or insurance industry including direct experience in dental benefits administration
- Comprehensive understanding of dental benefit plan design, administration, and reimbursement methodologies
- Knowledge of claim adjudication processes, coordination of benefits, down coding, bundling, and non-covered services policies
- Familiarity with provider network contracting, fee schedules, utilization management, and prior authorization practices
- Must have verbal communication, writing, analytical, facilitation, collaboration, presentation, a self-starter, results-focused skills
- Proficiency in M365 (MS Office)
- Travel twice per year, 1-3 nights per trip for attendance at CDBP or ADA meetings, industry conferences/events such as AADC, or other meetings as assigned
- Position may require before or after hours work and/or may require weekend work
Desired Qualifications
- American Association of Dental Consultants (AADC) Certification or Dental Coding or Reimbursement Certification (e.g. Dental Coding Consultant or Dental Benefit Specialist)
- Certification in health or dental benefits administration, such as Certified Employee Benefit Specialist (CEBS), Health Insurance Associate (HIA)
- Promotes Work/Life Balance
- Hybrid Work Schedule (2-3 days from home)
- Health insurance/ dental reimbursement plan
- Ample Paid time off
- Flexible Spending Account
- Life insurance
- Tuition reimbursement
- Paid Parental Leave
- Pet Insurance
- Student Loan Refinance
- 2 days off to work at a charity event of your choice
- The ADA values a variety of backgrounds and experiences and is committed to providing
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