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! 

General Summary:

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 overpayments, 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.

Principal Duties and Responsibilities

• 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 overpayments 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 perform other duties as assigned.

Job Specifications

• High School or equivalent business experience preferred.
• Advanced decision-making, problem-solving, and analytical skills.
• Excellent communication skills—verbal, written, and listening—with strong interpersonal abilities.
• Demonstrated expertise in interacting effectively and professionally with internal and external partners.
• Self-motivated and independent, with the ability to thrive in both team-based and autonomous work environments.
• Adaptable and effective in a continuously changing environment.
• Operates with a strong sense of urgency and consistently makes fair, balanced decisions with integrity.
• Highly efficient in time management and capable of managing multiple priorities simultaneously.
• Strong research, critical thinking, and attention-to-detail skills.
• Demonstrates initiative and a proactive approach to problem-solving and collaboration.

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~IN1

Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.

Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status.

The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience.

$40,000.00-$75,600.00

Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not.  All benefits are subject to the terms and conditions of individual Plans.

Company:

Unum