Dental Vision Benefit Specialist

Unum•Portland, ME

2d•$40,000 - $75,600

About The Position

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.

Requirements

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.

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.

Benefits

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