Credentialing Specialist

at UNUM in Portland, Maine, United States

Job Description

Job Posting End Date: April 21

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 Credentialing Specialist is responsible for the credentialing and recredentialing of providers in compliance with internal standards, policies and procedures. This includes entering data, performing appropriate credentialing verifications, preparing and files for various internal and external entities. The Credentialing Specialist will assist in conducting Credentialing Delegation Reviews as well as preparation and delivery of monthly and quarterly reporting for various persons.

Principal Duties and Responsibilities

+ 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

+ Assists providers with all questions related to provider credentialing

+ Performs provider re-credentialing, at least every 36 months in compliance with NCQA standards

+ Assists 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

+ Assists in preparing and delivering monthly and quarterly reports to various Delegated Entities

+ Assists in monitoring of license expirations and any change in status and takes action when appropriate

+ Assists in reviewing and updating criteria and credentialing policies and procedures, as necessary, but at least annually

+ 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 Records

+ Always maintains provider and patient confidentiality

+ Provides positive, supportive, communication to providers at all times

+ Collaborates with other departments and outside agencies to meet identified needs of the providers and their patients, while also ensuring credentialing staff cooperation

+ Other duties as may be assigned

Job Specifications

+ Associates degree preferred or equivalent experience

+ Minimum 3+ years of experience in Provider Credentialing or equivalent experience

+ Strong verbal and written communication skills

+ Strong data entry skills

+ High level of accuracy and attention to detail

+ Ability to gain high level of knowledge involving intricate aspects Systems of Record

+ Strong customer service philosophy

+ Critical thinking and problem-solving abilities

+ Familiarity with Microsoft Office, with strong Excel skills

+ Ability to thrive in a fast-paced environment and meet assigned deadlines



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.

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.


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.


Starmount Life

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.

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Job Posting: JC236473026

Posted On: Mar 17, 2023

Updated On: Apr 23, 2023

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