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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.

** This is a contract position with Sunlife. Part time, 10 hours/week (may be able to add additional hours on Fridays) **

The Oportunity: The Dental Consultant, MassHealth Board of Hearings is the assigned representative of decisions for coverage made by DentaQuest as the third-party administrator on behalf of the MassHealth Dental Program at the Massachusetts Board of Hearings.

• Work with the DentaQuest MassHealth team to attend in person scheduled hearings for members who have appealed to the Massachusetts Board of Hearings on Mondays, Wednesdays and occasionally on Fridays. Hearings locations vary, but are held primarily in Quincy, with additional locations including Tewksbury, Taunton, or Springfield, Massachusetts.
• Prepare a thorough review of the prior authorization decision, state regulations and the office reference manual for each appealed case prior to hearing.
• Represent DentaQuest [and MassHealth] with respect to the decision determined in compliance with state regulations at each hearing.
• Work collaboratively with the MassHealth / DentaQuest dental consultant team supporting the Massachusetts Board of Hearings to ensure consistency in the application of the rules and regulations established by MassHealth for the plan regarding the decisions made for coverage.
• Document hearing interactions / decisions and communicate to the MassHealth DentaQuest team for tracking and appropriate action.
• Attend meetings with the MassHealth team at DentaQuest and complete online training as needed.
• Other duties as assigned

What you will bring with you:

Preferred:

• Dental Provider / Specialist who is board certified in orthodontics or board eligible and graduated from a Commission on Dental Accreditation approved program.
• 10 years experience in practice as a licensed orthodontic dental provider in Massachusetts.
• Ability to provide transportation to and attend hearings at any location deemed necessary per the schedule from the Massachusetts Board of Hearings.
• Excellent oral and written communication skills.
• Efficient PC skills (E-mail, Word, Excel).
• Ability to work as a team member.
• Required to attend additional training as requested/deemed necessary.

Required:

• Massachusetts active dental license in good standing required.

PHYSICAL DEMANDS:

• Incumbent must be able to communicate effectively.
• Requires overall light physical effort (up to 25lbs.)
• Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal computer).
• Ability to travel or move about within and outside serviced facilities required.
• Incumbent works primarily remotely and attending Board of Hearings cases in Quincy, Tewksbury, Taunton, or Springfield, Massachusetts.

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.

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