Provider Onboarding and Credentialing Specialist

Job Posting End Date: June 05

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:

The Provider Onboarding and Credentialing Specialist will be responsible for ensuring a successful onboarding for new in network dental PPO, dental DHMO, and vision providers. They are responsible for taking the completed provider application and information, entering the data into the Salesforce System for tracking, reviewing and managing incomplete information and gathering of necessary information from the provider, and doing all initial credentialing and recredentialing of providers in compliance with internal standards, policies and procedures. This includes entering data, performing appropriate credentialing verifications, and preparing files for various internal and external entities. The Specialist will assist in conducting Credentialing Delegation Reviews as well as preparation and delivery of monthly and quarterly reporting as requested.

Principal Duties and Responsibilities

• Manage pending/incomplete contracts and workflow to efficiently gather all missing contracting documents
• Identify errors in initial contracting and missing items for completion
• Contribute to individual quality/production expectations to ensure the achievement of organizations turnarounds time expectations
• Perform a check on contracts to make sure appropriate fee schedules for area is utilized
• Work closely with Provider Network Recruitment to communicate and follow-up on missing contract elements
• Input contract data into provider databases while ensuring the accuracy of the data
• Responsible for entering in contracts in a timely manner for monthly metrics and recruitment reporting
• When requested may assist with Credentialing Delegation Reviews by presenting credentialing files to various Delegated Entities and/or reviewing credentialing files, policies and procedures and other monitoring reports to ensure compliance of various Delegated Entities
• Works directly with providers to ensure all necessary credentialing information has been received prior to beginning the credentialing process
• Enters provider data into appropriate data management systems
• Performs all credentialing verifications necessary to complete the credentialing process while maintaining the appropriate compliance standards
• Prepares and presents providers records for Credentialing Committee Review
• Notifies providers of credentialing decisions within compliance timeframes
• Performs provider re-credentialing, at least every 36 months in compliance with NCQA standards
• Assists in monitoring of license expirations and any change in status and takes action when appropriate
• Educates providers regarding criteria and credentialing policies and procedures when necessary
• Works with Network Management to ensure providers’ initial information and updates are sent for processing timely and accurately
• Assists Network Management and Support staff with provider data management as it relates to adding new providers in System of Record
• Sends all approval and welcome kits to providers in a timely manner
• Always maintains provider and patient confidentiality
• Provides positive, supportive, communication to providers at all times