Sun Life · 1 month ago
Director, Regulatory and Managed Care Compliance, DentaQuest (California)
Laguna Hills, California
Full-time
Onsite
Mid, Senior Level
$133K/yr - $199K/yr
5+ years expSun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. The Director, Regulatory and Managed Care Compliance will lead compliance initiatives, develop relationships with regulatory agencies, and ensure adherence to state regulations within their business division.
FinanceFinancial ServicesInsurance
Responsibilities
Develop and maintain key relationships with the regulatory agencies, including but not limited to the California Department of Managed Health Care (DMHC) and Coordinated Care Organizations (CCOs) in their respective business division and region
Ensure compliance with all state regulatory and CCO audits in their respective business division and region
Coordinate corporate attendance and participate in all regular compliance and quality management meetings required in the Western Region
Ensure timely and accurate reporting and audit responses to all regulatory agencies and CCOs
Assume lead role in all tasks associated with compliance related matters
Direct and conduct investigations of potential compliance issues and development and implementation of any necessary corrective action plan
Direct and enforce all compliance policies and procedures and consistent application of sanctions for failure to comply
Monitor, research federal and state regulations and proposed regulations to determine applicability for the organization and/or business division and region and develop and execute strategies and proposed improvements or changes to current state
Develop, implement, and conduct periodic privacy risk assessments and related monitoring activities in coordination with Internal Audit and Compliance Program monitoring activities
Assume lead role in development and implementation of Fraud, Waste and Abuse deliverables, including FWA prevention handbook, annual prevention plan, quarterly reporting and annual assessment
Other duties as needed or required
Qualification
Required
BA or BS degree in related field required
5+ years' experience with Managed Care and/or CCO programs and compliance
Ability to assume a reasonable level of individual responsibility, to handle multiple projects and responsibilities at the same time and to work collaboratively in a nonhierarchical department structure
Ability to building strong relationships with leadership, industry partners and regulatory entities to maintain and further develop the Organization's strong culture of ethics and compliance at all levels in the organization
Strong understanding of legal and regulatory knowledge and experience in operational implementation
Demonstrated knowledge and understanding of emerging trends and regulatory requirements
Detail-oriented individual with excellent analytical, organizational, problem-solving, and interpersonal skills
Excellent interpersonal skills and demonstrated ability to work collaboratively on a team among diverse groups
Exceptional written and verbal communication skills
Ability to develop and/or interpret complex regulatory requirements and the ability to communicate technical and complex concepts
Attends additional training as requested/deemed necessary
Preferred
Healthcare/dental management or administration or related field preferred
Benefits
Generous vacation and sick time
Market-leading paid family, parental and adoption leave
Medical coverage
Company paid life and AD&D insurance
Disability programs
Partially paid sabbatical program
401(k) employer match
Stock purchase options
Employer-funded retirement account
Company
Sun Life
Sun Life is a leading financial services organization dedicated to helping people achieve lifetime financial security and live healthier lives.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$1.05B2024-05-13Post Ipo Debt· $548.79M
2023-07-04Post Ipo Debt· $500M
2000-03-24IPO
Leadership Team
Kevin Strain
President & CEO
Luc Nhon Ly
Chief Executive Officer
Recent News
2025-12-02
MarketScreener
2025-12-02
South China Morning Post
2025-11-27
Company data provided by crunchbase