Director of Insurance Plan Management
New
J
JobgetherDental insurance
Based in the United StatesFull-TimeDirector
Salary not disclosed
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Job Details
- Experience
- At least 10 years of experience in payer relations, payer operations, insurance plan management, or a related field.
- Required Skills
- Microsoft ExcelGoogle Sheets
Requirements
- Bachelor's degree in Business, Healthcare Administration, Economics, or a related field.
- MBA or MHA preferred.
- At least 10 years of experience in payer relations, payer operations, insurance plan management, or a related field.
- Deep understanding of dental reimbursement models, including fee-for-service (FFS), PPO, capitation, and value-based reimbursement.
- Strong knowledge of dental coding, claims processes, reimbursement dynamics, payer policies, and industry trends.
- Advanced financial and analytical capabilities, including expert-level Excel or Google Sheets modeling, scenario planning, and sensitivity analysis.
- Ability to evaluate complex contract terms, quantify financial trade-offs, and communicate recommendations to executive leadership.
- Proven negotiation skills and a track record of developing payer relationships and securing agreements.
- Strong change management and stakeholder alignment skills, including translating strategic objectives into execution plans.
- Experience using CRM systems, contract management repositories, analytics dashboards, and performance reporting tools.
- Ability to work autonomously, manage multiple priorities, and collaborate in a fast-paced, partially remote environment.
- Willingness to travel up to 25% as business needs require.
Responsibilities
- Lead negotiations with commercial and government-sponsored dental payers on fee schedules, contract structures, value-based arrangements, and performance incentives.
- Develop financial pro formas, scenario models, and sensitivity analyses to assess proposed agreements.
- Manage market-level payer portfolio strategies, including payer mix and network participation decisions.
- Analyze competitor positioning, payer strategies, regulatory developments, and internal performance data to set negotiation priorities.
- Partner with field operations and clinical leadership on plan participation, fee-schedule implementations, provider onboarding, and workflow changes.
- Build senior-level payer relationships and establish regular quarterly business reviews and issue-resolution pathways.
- Resolve provider-payer disputes and strengthen data quality, processes, and escalation protocols.
- Develop negotiation playbooks, templates, and standardized processes for colleagues and field leaders.
- Establish and monitor insurance plan management KPIs, prepare management reports and executive presentations, and identify corrective actions.
- Use CRM platforms, contract repositories, analytics dashboards, and reporting tools to manage negotiation pipelines and payer review schedules.
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