Dental Vision Benefit Specialist

Job Posting End Date:
March 04

When you join the team at Unum, you become part of an organization committed to helping you thrive.

Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life’s moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:

• Award-winning culture
• Inclusion and diversity as a priority
• Performance Based Incentive Plans
• Competitive benefits package that includes:
  Health, Vision, Dental, Short & Long-Term Disability
• Generous PTO (including paid time to volunteer!)
• Up to 9.5% 401(k) employer contribution
• Mental health support
• Career advancement opportunities
• Student loan repayment options
• Tuition reimbursement
• Flexible work environments

All the benefits listed above are subject to the terms of their individual Plans.

And that’s just the beginning…

With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you’re directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today!

This position within the Dental and Vision Claims organization requires advanced expertise in claims processing and adjudication. The role is responsible for evaluating benefit eligibility, processing approvals and denials, and ensuring the timely and accurate adjudication of complex dental and vision claims. The role also handles escalated claim inquiries from internal business partners, claim appeals, and privacy incident research, and documentation.

In addition to claims responsibilities, this position manages billing and reconciliation of claim payments. This includes identifying and resolving over payments, coordinating recovery efforts directly with members or providers in accordance with policy language, and ensuring all necessary documentation is available for accurate determinations.

The role requires in-depth claim knowledge, systems proficiency, and informed decision making based on documented procedures and policies. The Senior Benefit Specialist also partners with Unum’s third-party vendors and contributes to operational projects.

Existing remote employees are eligible to apply.

• Demonstrate advanced knowledge to evaluate all information in claim files to determine appropriate adjudication and next steps.
• Manage complex claims, including escalations, appeals, grievances, and ensure timely and accurate resolution.
• Apply an advanced understanding of applicable claim provisions, clauses, waivers, and regulatory requirements across all administered products.
• Examine complex claims for appropriateness of care and completeness of documentation, ensuring compliance with federal and state regulations.
• Interact with internal business partners to resolve claims issues, obtain missing information, and ensure accurate and complete claim documentation.
• Navigate across training and internal documentation to reference information on dental and vision products, policies, departmental procedures, and claims systems.
• Perform payment runs and accurately document payment information for accounting and audit purposes.
• Serve as the primary liaison with payment vendors to manage research issues, voids, reissues, and other payment-related inquiries.
• Conduct research, analysis, and resolution of undeliverable or refunded payments; manage collections for over payments and process billing adjustments and recoupments.
• Investigate, manage, and report privacy incidents, ensuring compliance with privacy standards.
• Research and resolve inquiries from customers, providers, field representatives, and brokers to ensure a high level of service and satisfaction.
• Identify trends and process improvement opportunities; provide feedback to support continuous improvement and operational effectiveness.
• Assist with upskilling and knowledge support of new and existing staff as needed.
• May…