Director of Insurance Plan Management

Accountabilities:

As Director of Insurance Plan Management, you will own the strategy and execution of payer negotiations, contract optimization, and network participation. You will use financial analysis and market intelligence to drive sustainable growth while partnering across departments to ensure that negotiated agreements translate into improved operational and financial outcomes.

• 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 to improve patient access and enterprise value.

• Analyze competitor positioning, payer strategies, regulatory developments, and internal performance data to establish negotiation priorities and develop effective contracting strategies.

• 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 regular quarterly business reviews (QBRs) and effective pathways for resolving issues and improving negotiation outcomes.

• 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 to improve consistency and strengthen the negotiation capabilities of colleagues and field leaders.

• Establish and monitor key performance indicators related to insurance plan management, tracking results against budgets and identifying corrective actions, owners, and timelines.

• Prepare management-level reports and executive presentations that support transparent performance monitoring and data-driven decision-making.

• Work cross-functionally with revenue cycle, operations, clinical leadership, and other stakeholders to align insurance plan strategies with broader organizational goals.

• Identify opportunities for process improvement, technology adoption, and innovation to enhance payer management, contracting efficiency, and operational performance.

• Use CRM platforms, contract repositories, analytics dashboards, and standardized reporting tools to manage negotiation pipelines, payer review schedules, and executive communications.

• Lead change initiatives by translating complex strategies into clear implementation plans and ensuring alignment across relevant teams.

Requirements:

The ideal candidate is a commercially minded, results-oriented leader with deep expertise in payer relations, dental reimbursement, financial analysis, and cross-functional execution. You should be able to negotiate confidently using data and sound judgment, build trusted relationships with senior stakeholders, and turn complex contracting strategies into measurable business outcomes.

• Bachelor's degree in Business, Healthcare Administration, Economics, or a related field. An MBA or MHA is 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 clearly to executive leadership.

• Proven negotiation skills and a track record of developing payer relationships and securing agreements that improve financial and operational performance.

• Strong change management and stakeholder alignment skills, with the ability to convert strategic objectives into actionable execution plans.

• Excellent communication, relationship-building, and influencing skills, supported by high emotional intelligence and a credible executive presence.

• Strategic and systems-oriented thinking, connecting payer contracting decisions with practice-level operations, provider economics, and patient experience.

• Strong problem-solving skills, resilience, and adaptability when working through ambiguity, competing priorities, and rapid organizational growth.

• A coaching and continuous-improvement mindset, with the ability to develop repeatable processes and strengthen the capabilities of broader teams.

• Experience using CRM systems, contract management repositories, analytics dashboards, and performance reporting tools to manage negotiation pipelines and monitor results.

• Ability to work autonomously, manage multiple priorities, and collaborate effectively in a fast-paced, partially remote environment.

• Willingness to travel up to 25% as business needs require.

Benefits:

• The opportunity to lead high-impact payer negotiations that directly influence revenue growth, profitability, and market expansion.

• A senior leadership role with ownership of insurance plan strategy, contract negotiations, and network optimization.

• Opportunities to collaborate with executive stakeholders and cross-functional teams spanning clinical leadership, operations, revenue cycle, and analytics.

• The ability to shape negotiation frameworks, establish scalable processes, and influence organizational strategy.

• A dynamic, growth-oriented work environment with opportunities to drive innovation and continuous improvement.

• A partially remote working environment.

• Travel opportunities of up to 25%, depending on business requirements.

• Salary, healthcare coverage, retirement plans, paid leave, and other specific benefits were not provided in the source description.