Claims Referral Specialist I

About the role

The Claims Referral Specialist I plays a crucial role in ensuring the timely and accurate processing of dental claims, pre-authorizations, and referrals.

Responsibilities

• Process dental claims, pre-authorizations, and referrals accurately and within required turnaround times.
• Perform high-volume data entry while maintaining accuracy and efficiency.
• Review and determine benefits according to plan guidelines and processing requirements.
• Maintain knowledge of service level agreements (SLAs) and applicable state regulations.
• Meet or exceed established production and quality goals.
• Support a positive, collaborative team culture.
• Follow established procedures, policies, and safety protocols.
• Perform additional duties and special projects as assigned.

Requirements

• High school diploma or GED.
• Minimum of one year of dental claims processing or related experience.
• Proficiency in Microsoft Office, including Excel, Outlook, and Word.
• Ability to work independently and successfully meet performance objectives.
• Typing speed of at least 40 words per minute.
• Strong 10-key data entry skills.
• Excellent communication and customer service skills.
• Strong attention to detail and organizational abilities.

Qualifications

• Required qualifications: High school diploma or GED, minimum of one year of dental claims processing or related experience, proficiency in Microsoft Office, ability to work independently, typing speed of at least 40 words per minute, strong 10-key data entry skills, excellent communication and customer service skills, strong attention to detail and organizational abilities.
• Preferred qualifications: Registered Dental Assistant (RDA) certification, front office and/or back office experience in a dental practice.