Associate Director, Quality & Compliance Oversight, California Market, DentaQuest

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

Location: Individual must me located in the state of California.

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America. 

The opportunity: 

This position is responsible for contractual and regulatory quality and compliance for California government program clients. In addition, this position serves as the compliance subject matter expert (SME) to the operational leads in implementation of contractually and regulatorily compliant processes. Administers an organizational quality management system and monitors progress against strategic and contractual quality-related goals.
The Associate Director, Quality Oversight provides operational guidance in the effective delivery of services to clients, members, and stakeholders. Through partnership with operational team leads, s/he collaborates on service delivery, corporate and division strategic priorities and compliance with implementation of all regulatory requirements, including but not limited to quality, fraud, waste and abuse, diversity, equity and inclusion, and civil rights. This position reports to a director within the Compliance department.

How you will contribute: 

• Serves a quality and compliance contact and is responsible for overall compliance with contractual, federal, state and local laws, rules and regulations affecting California Quality and Compliance programs.

• Monitor, research federal and state regulations and proposed regulations to determine applicability for Company and works with Government Relations and Legal to ensure appropriate application of laws and regulations

• Develops training programs to ensure DentaQuest is meeting its legal and contractual obligations

• Coordinates and communicates to internal departments and external clients and vendors, where appropriate, all compliance activities and programs, as well as integrates the California Compliance and Quality Programs into the Company’s Compliance Program and Workplan

• Maintain up-to-date knowledge of developments in all legislative and regulatory implications for DentaQuest California.

• Oversees the operational aspects of California compliance and Quality, working closely with leadership in operational areas to provide audit and monitoring oversight, as well as information to ensure they know regulatory and contractual requirements. Assists operational departments with review of policies and procedures designed to ensure compliance with contract obligations and other applicable requirements

• Assist account/operational management in responding to health plan and DHCS audits and provide technical assistance to improve performance, as needed and requested

• Oversees implementation of initiatives associated with contractual operational compliance and quality and drives to completion

• Develops policies and procedures to ensure DentaQuest’s Operations in is compliance and assists with the development of policies and procedures specific to operational areas

What you will bring with you: 

• Five years’ experience in government programs product management, regulatory affairs, operations or other similar healthcare related government programs function preferably in health care/managed care environment

• Up-to-date knowledge of state and federal laws and regulations, including Medicare/Medicare Advantage and Medicaid requirements

• Proven ability to influence cross-functional teams without formal authority, including skills in collaborating and influencing others

• Excellent interpersonal and communication skills (verbal, written and presentation) required for formal reports and updates

• Ability to read statutes and regulations and interpret them in order to identify compliance needs/risks, etc.

• Attend additional training as requested/deemed necessary

Preferred:

• Analytical skills to interpret, predict and improve process and performance

• Attention to detail

• Strong verbal and written communication skills

• Strong knowledge of Microsoft Office Systems

• Charts and Graphs

Do you see yourself in this role even if you haven’t checked all the boxes above? We welcome all talented candidates and are committed to a culture that represents diversity in all forms. If you think you might thrive in this setting, we would love to hear from you. 

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you! 

Life is brighter when you work at Sun Life 

• Excellent benefits and wellness programs to support the three pillars of your well-being – mental, physical and financial – including generous vacation and sick time, market-leading paid family, parental and adoption leave, a partially-paid sabbatical program, medical plans, company paid life and AD&D insurance as well as disability programs and more 

• Retirement and Stock Purchase programs to help build and enhance your future financial security including a 401(k) plan with an employer-paid match as well as an employer-funded retirement account  

• A flexible work environment with a friendly, caring, collaborative and inclusive culture  

• Great Place to Work® Certified in Canada and the U.S.  

• Named as a “Top 10” employer by the Boston Globe's “Top Places to Work” two years running 

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. 

Salary Range: $97,400 - $146,100
At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter -for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more. 

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.  

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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 [email protected] 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.

Compliance

27/03/2025

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.