Claims Referral Specialist II

About The Role

The Claims Referral Specialist II is responsible for the daily processing of dental claims, referrals, and/or pre-authorizations while maintaining high standards for accuracy, quality, and productivity. This role requires a strong understanding of benefit determination, claims adjudication processes, service level agreements, and regulatory requirements.

Responsibilities

• Process dental claims, referrals, pre-authorizations, and related transactions within established timelines and service level agreements.
• Perform accurate data entry and documentation.
• Determine eligibility and benefits while processing claims, specialty referrals, and pre-authorizations.
• Maintain current knowledge of processing requirements, state regulations, and service level agreements.
• Support a collaborative team environment and contribute to operational success.
• Follow established protocols to maintain a safe and productive work environment.
• Perform additional duties and special projects as assigned.

In this role, you will have advanced processing capabilities and be able to:

• Process all claims for your assigned location, including coordination of benefits (COB) and orthodontic claims, or
• Process pre-authorizations and referrals across all lines of business for the location and process claims for at least one line of business.

Requirements

Required Qualifications

• High school diploma or GED.
• Minimum of 1 year of dental claims processing experience.
• Proficiency with Microsoft Office, including Excel, Outlook, and Word.
• Ability to work independently and consistently meet performance objectives.
• Typing speed of at least 40 words per minute.
• Proficiency with 10-key by touch.
• Strong communication, customer service, and interpersonal skills.

Preferred Qualifications

• Registered Dental Assistant (RDA) credential.
• Front office and/or back office dental office experience.

Success in This Role

Successful Candidates Will Demonstrate:

• Strong attention to detail and accuracy.
• The ability to understand and follow written and verbal instructions.
• Reliability, punctuality, and regular attendance.
• A team-first mindset and commitment to quality service.
• The ability to manage workload efficiently while meeting production and quality expectations.

Work Environment

• Office-based work environment with standard office equipment.
• Sedentary position that requires extended periods of sitting, typing, and close-range computer work.

Benefits

We strive to care for employees in ways that promote wellness and productivity. Our first-class benefits package supports employees and their dependents with:

• Competitive pay structure and savings options to help you reach your financial goals.
• Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines.
• Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan.
• 100% employer-paid dental coverage for employees and eligible dependents.
• Vision insurance with low-cost premiums for employee-only coverage and dependents.
• Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage.
• Flexible Spending Accounts for healthcare and dependent care expenses.
• Voluntary benefit programs, including accident, critical illness, and hospital indemnity insurance.
• Long-term disability coverage.
• Expansive wellness programs, including company-wide wellness challenges, and gym discounts.
• Employee Assistance Program (EAP) to support mental health and well-being.
• Generous vacation and sick leave policies, with the ability to roll over unused time.
• 10 paid company holidays.
• Tuition reimbursement for eligible educational expenses.
• Remote or hybrid work options available for various positions.

Pay

The base salary range for this position is $20.00 - $25.00 hourly, not including fringe benefits or potential bonuses. At Liberty, your final base salary will be determined by factors such as geographic location, skills, education, and experience.

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time.