Director of Insurance Plan Management

Position listed on behalf of a partner company that manages all applications and next steps. The partner is looking for a Director of Insurance Plan Management based in the United States.

• Lead strategic negotiations with commercial and government-sponsored dental payers to secure competitive fee schedules, favorable contract structures, value-based arrangements, and performance incentives
• Develop, evaluate, and present financial pro formas, scenario models, and sensitivity analyses to quantify the impact of proposed agreements on revenue, contribution margin, and provider economics
• Manage market-level payer portfolio strategies by evaluating payer mix, identifying opportunities to add or exit plans, and optimizing network participation
• Analyze competitor positioning, payer strategies, regulatory developments, and internal performance data to establish negotiation priorities
• Collaborate with field operations and clinical leadership to align plan participation decisions, fee-schedule implementations, provider onboarding, and downstream workflow changes
• Build and maintain senior-level relationships with payer organizations, establishing quarterly business reviews (QBRs)
• Resolve complex provider-payer disputes by identifying root causes and strengthening data quality, processes, and escalation protocols
• Develop negotiation playbooks, templates, standardized processes, and best practices
• Establish and monitor KPIs related to insurance plan management
• Prepare management-level reports and executive presentations
• Work cross-functionally with revenue cycle, operations, clinical leadership, and other stakeholders
• Identify opportunities for process improvement, technology adoption, and innovation
• Use CRM platforms, contract repositories, analytics dashboards, and standardized reporting tools
• Lead change initiatives by translating complex strategies into clear implementation plans

• 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), preferred provider organization (PPO), capitation, and value-based reimbursement arrangements
• Strong knowledge of dental coding, claims processes, reimbursement dynamics, payer policies, and emerging industry trends
• Advanced financial and analytical capabilities, including expert-level Excel or Google Sheets modeling, scenario planning, and sensitivity analysis
• Demonstrated 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
• Strong change management and stakeholder alignment skills
• Excellent communication, relationship-building, and influencing skills
• Strategic and systems-oriented thinking