Job details

Head of Dental Clinical Policy

Head of Dental Clinical Policy, Group Benefits

About us

Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being — mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com.

Role Summary

Reporting to the Head of Claims Management, Group Benefits, the Head of Dental Clinical Policy is responsible for aligning the claims clinical strategy and policy. This individual will work with dental product to drive a clinical policy that is competitive and market leading that will improve claims outcomes and drive profitable growth. This role will spearhead the clinical strategy and policy that will influence and determine how we handle dental claim adjudication which drives our financial outcomes. This Leader will be the face of Guardian dental clinical policy to the external market including the professional dental community, and industry, and act as a support resource to sales and client management, claims resolution and customer service colleagues by providing dental consultative services in regards to plan design for clients, participation in finalist sales presentations, providing a clinical resource in relation to client/field questions and claim resolution, and positioning Guardian’s value proposition in the marketplace.

This individual will participate in Guardian quality assurance, utilization review, and related task forces or committees, such as those involving cost of care, product development, procedures subject to abuse, etc. The role ensures the provision of proactive patient care that optimizes the dental health of the patient population of each community served through Guardian dental products and programs. This requires the coordination of activities with dental providers, Guardian personnel, senior management, dental advisors, dental consultants, professional societies, and regulatory agencies. In addition, this role provides leadership and development to internal reviewing dentists as well as dental consultants.

You Will:

Establishes dental policy for application in determining all claim payment and pre-payment review decisions to ensure dental loss ratio is effectively and appropriately managed.
Provide thought leadership and direction to dental cost management activities including utilization management program effectiveness, utilization review, fraud/abuse detection, dental reimbursement, benefit design, member management and other tools to assist in the management of dental costs.
Ensures consistent quality of care standards for Guardian consistent with policy language, adherence to state specific regulatory requirements that meet clinical quality standards.
Develops and implements consistent clinical review policies and processes.
Provides thought leadership by educating internal dentists.
Promotes a culture of constant growth, learning and improvement.
The Head of Dental Claims Strategy and Policy serves as a liaison to the professional dental community, and represents Guardian in industry, governmental, and public relations capacities. This includes, for example, making presentations to professional societies, contributing articles to internal and external journals and publications and communicating professional concepts to lay, professional, and regulatory audiences.
Assists in projects as assigned, providing a professional dental perspective to areas such as product development, network management claim review logic and claim standards.
Leads critical corporate professional affairs activities. Most notably, these activities involve responding to inquiries/areas of noncompliance identified as a result of state Department of Insurance audits; providing RFP input for large or otherwise critical business prospects; and leading or participating in other projects as business needs dictate.

You Have:

DDS or DMD degree from an ADA accredited dental school required.
10 plus years of clinical experience required; 5-10 years of progressively responsible dental management/insurance industry experience preferred.
Have knowledge of regulatory guidelines and issues relating to dental managed care.
Have knowledge of the dental insurance industry relating to clinical dental policies.
Superior communication and presentation skills.
Must be analytical and detailed oriented, with solid organizational skills.
Must be goal and deadline oriented with strong negotiation skills.
Will require travel as necessary to support these programs and establish clinical leadership and eminence across the industry.

Location

The primary location for this position is remote with occasional travel

Our Promise

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Salary Range

$119,500.00 - $196,330.00

The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

Inspire Well-Being

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.

Health Care

Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits
Dental plan
Vision plan
Health care accounts – flexible spending, health reimbursement, and health savings accounts
Critical illness insurance

Life and Disability Insurance

Company-paid Life and Disability insurance plus voluntary supplemental coverage
Accident insurance

Retirement and Financial

401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable
Complimentary 1:1 financial guidance with a licensed Fidelity representative

Time Off and Remote Work

Flexible work arrangements (part in-person/part remote)
Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement
Personal holidays for colleagues to use in recognition of religious, cultural, or civic days
Paid parental leave and paid family and medical leave policies

Emotional Well-being and Work-Life

Emotional well-being, mental health, and work/life resources powered by Spring Health
Wellness programs, including fitness program and equipment reimbursement
Child, adult, and elder back-up care support through Bright Horizons
Adoption assistance
College planning
Tuition reimbursement
Student loan assistance
Commuter benefits in select metropolitan areas

Justice, Equity, Diversity & Inclusion (J.E.D.I.)

Employee Resource Groups that advocate for inclusion and diversity
J.E.D.I. certification and training programs
Matching gifts/volunteering

Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.

Equal Employment Opportunity

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact

applicant_accommodation@glic.com

By Guardian Life

In 2021, we expanded our purpose as an organization to inspire well-being™. We established Guardian’s North Star going forward and began a three- to five-year process of transformation and progress. The effort gained momentum last year across our ...

FUNDING

INDUSTRY

TEAM SIZE

LOCATION

Hybrid, based in New York, NY

DATE POSTED

June 10, 2023