Dental Policy & Quality Manager

Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care.   G.E.H.A has one mission: To empower federal workers to be healthy and well. The Dental Policy & Quality Manager owns the clinical policy, coding, education, and data quality functions that ensure G.E.H.A’s dental benefit programs operate with accuracy, consistency, and clinical integrity. This role sits within the product team and serves as the organization's recognized clinical authority on dental benefit policy, CDT coding standards, and coverage criteria — providing the clinically defensible policy foundation that the program depends on to make sound, defensible decisions. This is a senior-level individual contributor role carrying functional authority over the clinical policy and quality discipline, requiring deep dental clinical and benefit expertise combined with the ability to translate that expertise into practical program infrastructure — documented policies, provider and member education, coding alignment with vendors, and accurate data reporting to the Office of Personnel Management (OPM). Initially, the role carries significant foundational work: auditing and realigning existing coverage policies against G.E.H.A's actual program needs, current CDT standards, and vendor adjudication practices. Over time it transitions into ongoing ownership, maintenance, and continuous improvement of those systems. Coverage determinations, clinical review criteria, and coding standards approved through this role establish the governing policy direction for G.E.H.A’s third-party administrator and clinical review vendor and are used to support OPM audits and regulatory reviews. SKILLS Duties & Responsibilities Dental Coverage Policy Development & Governance Own development, documentation, and ongoing maintenance of G.E.H.A's dental coverage policies, including benefit criteria, code-level guidance, annual CDT updates, and a version-controlled policy library that serves as the program's source of truth. Lead the initial policy audit and realignment effort by identifying outdated language, coverage gaps, coding inconsistencies, and misalignment with CDT standards, vendor adjudication practices, clinical review criteria, and G.E.H.A plan provisions. Serve as G.E.H.A's final dental policy and coding authority for TPA and clinical review vendor alignment, OPM filings, benefit reviews, member escalations, audit findings, and interpretation of coverage requirements. Coordinate the annual BENEFEDS CDT reporting process with TPA and Data & Analytics, ensuring accurate validation and timely…