Manager, Contract Implementation and Compliance

Location: Milwaukee, Wisconsin, United States

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Remote Opportunity: 1

Requisition Number: 3609

Position Title: Manager, Contract Implementation & Compliance

External Description:

JOB SUMMARY:

The Manager, Contract Implementation & Compliance, will lead the state and health plan contract execution process for a particular set of regions, with responsibility for determining that proposed contract terms can be implemented and, upon contract signing, are implemented.  In addition, this position will oversee the drafting Evidence of Coverage documents, including Subscriber Certificates and Subscriber Policies, Schedules of Benefits, Benefit Riders, Group Agreements, and other product description documents for a particular set of regions.

This position will have experience with client contracts and will be expected to manage the contract process from the start of the opportunity through contract execution, including reporting on the status of deals.  The Manager will seek input from key stakeholders for contract review and will manage competing priorities.  The Manager will also be responsible for the development, training and maintenance of the intent of deal (IOD) process for both new business and existing business.  The Manager must have the ability to motivate team members, drive change, and facilitate problem solving discussions as it pertains to process improvement, communication and reporting.  The manager will provide follow up and review after contract execution to monitor and drive compliance with contract terms.  The manager will play a central role as the organization reviews end to end contract compliance, and will play a central role in the implementation of the outcome of that process, with the specifics to be determined by that outcome.

PRIMARY JOB RESPONSIBILITIES:

Contract Implementation & Compliance

  • Lead cross-functional teams to complete the review and execution of new client contracts.
  • Provide concise documentation that supports the contract review process, representing key business decisions, and obtain sign off from stakeholders.
  • Manage review of contract terms for implementation issues.
  • Lead development of end to end contract compliance process and implement the outcomes of that process.
  • Manage rollout and training of the contract database. Train client services staff on review/approval process for changes to existing client contracts.
  • Maintain current Risk, ASO, LOI, LOA, NDA and BAA agreements in contract database to ensure accessibility and consistency.
  • Continually improve the IOD process (system set-up, maintenance and communication) for new and existing business. Serve as the point of contact for questions as it relates to the IOD process.
  • Identify areas of improvement for new opportunity/sales process that impact the organization and implement improvements.
  • Present and facilitate effective meetings.
  • Provide training to internal staff for the new and existing IOD process.
  • Manage and mentor direct reports.
  • Represent DentaQuest in a professional manner at all times.
  • Other duties as assigned.

 

Benefits Documents

  • Oversee the drafting of Evidence of Coverage and related documents, including Subscriber Certificates and Subscriber Policies, Schedule of Benefits, Benefit Riders, Group Agreement and other product descriptions setting forth benefits available to members.
  • Supervise the filing of final benefit documents and product descriptions with state regulators across the assigned region(s), using the SERFF system among other filing methodologies.
  • Act as secondary contact with regulators across the country with respect to product design and filing matters.
  • Outreach to and communicate with state regulators regarding benefit documents and the Company’s products.
  • Manage outside counsel regarding the same.
  • Work and communicate with the company’s marketing department regarding the same.
  • Work on company’s product design teams
  • Participate in product development efforts.
  • Coordinate relevant company personnel to provide the information necessary to prepare and file benefit documents and product descriptions.
  • Perform legal and factual research as necessary to support the above activities.

 JOB QUALIFICATIONS:

Required:

  • Bachelor’s degree required. Masters in relevant field desirable.
  • 5+ years sales, contracting or compliance experience or equivalent, preferably in healthcare or dental insurance with demonstrated progressive levels of responsibility, experience and leadership, with significant experience in product design matters and significant experience working with regulators
  • Understanding of legal terminology and principles
  • Deep understanding health insurance related products
  • Ability to perform legal research; familiarity with Lexis-Nexis and Westlaw
  • Excellent writing and proof-reading skills required
  • Must be highly organized with a strong attention to detail
  • Must have outstanding communication skills, written and verbal.
  • Excellent PC skills (Word, Excel and PowerPoint) and effective interpersonal skills.
  • Ability to work as a team member and manage direct reports.
  • Ability to work overtime as needed or required.

 PHYSICAL DEMANDS:

  • Ability to sit at a computer terminal for extended periods of time.
  • Ability to efficiently operate all job-related office equipment.
  • The office environment is active with high voice levels and interruptions that may challenge hearing and concentration.
  • Occasional overnight travel, in most cases by air.

City: Milwaukee

State: Wisconsin

Community / Marketing Title: Manager, Contract Implementation and Compliance

Company Profile:

We believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Company Profile Job:

At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Location_formattedLocationLong: Milwaukee, Wisconsin US

CountryEEOText_Description: In accordance with our Compliance Plan, employees must conduct business in accordance with applicable laws, regulations, professional standards and ethical standards and report potential compliance or ethical issues to manager or Compliance Officer. 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 see Human Resources for additional information regarding this Program. Equal Employment Opportunity Statement: We are committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, or sexual orientation.

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