Supervisor, Credentialing and Regulatory Operations
Guardian Life
full-time
Posted on:
Location Type: Hybrid
Location: Boston • Massachusetts • New Jersey • United States
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Salary
💰 $70,340 - $115,565 per year
Job Level
About the role
- Lead and develop multiple operational teams responsible for dental provider credentialing, recredentialing, and state-specific provider directory verification activities.
- Ensure team compliance with all applicable state, regulatory, and accreditation requirements, including Medicare Advantage-specific standards.
- Maintain oversight of team workloads and case progression to ensure provider applications and verifications move through the process within reasonable turnaround times and established service-level agreements.
- Drive consistent execution of credentialing and recredentialing cycles, ensuring quality, accuracy, and regulatory adherence across all files.
- Oversee provider verification activities, including outreach to dental offices to confirm demographic, practice, and directory information in support of state-specific requirements.
- Coordinate regulatory-driven outreach across credentialing, recredentialing, and provider verification processes to reduce provider burden, eliminate duplication, and leverage shared information (e.g., provider location changes).
- Partner with technology and operations leaders to identify opportunities for automation and digital enablement, including ongoing evaluation of agentic AI and other tools to improve efficiency, quality, and scalability.
- Serve as a key operational leader supporting continuous improvement, process optimization, and change management initiatives.
- Lead with a customer mindset, ensuring professional, coordinated, and consistent provider communications across teams.
Requirements
- Credentialing experience, with a strong understanding of regulatory and operational requirements specific to provider networks.
- Experience with Medicare Advantage credentialing requirements is preferred.
- Proven people leadership experience managing operational teams in regulated healthcare, insurance, or provider network environments.
- Deep knowledge and subject matter expertise of dental provider credentialing.
- A strong process and system orientation, with the ability to balance compliance, quality, productivity, and customer experience.
- Demonstrated ability to oversee complex, multi-team workflows while driving accountability and performance outcomes.
- Experience partnering with technology and transformation teams to identify and implement automation or digital solutions.
- Strong critical thinking and judgment, with the ability to assess risk, identify dependencies, and make informed decisions.
- Clear, confident communication skills and the ability to influence across operational, compliance, and leadership stakeholders.
- A continuous-improvement mindset and a track record of leading teams through change.
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development opportunities
- Bonuses
- Philanthropic opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
credentialingrecredentialingprovider verificationregulatory complianceMedicare Advantage requirementsprocess optimizationworkflow managementautomationdigital solutionsquality assurance
Soft Skills
people leadershipcritical thinkingjudgmentcommunicationinfluencecustomer mindsetaccountabilityperformance managementcontinuous improvementchange management