[Hiring] Claims Referral Specialist II @Liberty Dental Plan Careers

Role Description

As a Claims Referral Specialist II, you will be responsible for processing dental claims, pre-authorizations, and referrals within established service level agreements and regulatory guidelines. This role is ideal for someone who thrives in a fast-paced, production-driven environment, enjoys analytical work, and takes pride in maintaining high levels of accuracy and quality.

• Process dental claims, pre-authorizations, referrals, and benefit determinations accurately and efficiently.
• Review and adjudicate claims in accordance with plan guidelines, state regulations, and service level agreements.
• Process claims involving Coordination of Benefits (COB) and Orthodontic services.
• Perform high-volume data entry while maintaining established quality and productivity standards.
• Maintain current knowledge of claims processing requirements, regulatory updates, and departmental procedures.
• Collaborate with internal teams to resolve claim-related issues and support operational goals.
• Promote a positive, team-oriented work environment.
• Maintain confidentiality and professionalism in all interactions.
• Perform additional duties as assigned.

Qualifications

• High School Diploma or GED.
• Minimum one (1) year of dental claims processing experience.
• Valid New York Adjuster License or ability to obtain one within the 1st 90 days of hire.
• Must reside in an Eastern Time Zone state.
• Experience processing claims, including Coordination of Benefits (COB) and Orthodontic claims.
• Strong analytical and problem-solving skills.
• Ability to meet production and quality goals in a high-volume environment.
• Proficiency with Microsoft Office, including Excel, Outlook, and Word.
• Typing speed of at least 40 words per minute.
• 10-key by touch proficiency.
• Strong communication and customer service skills.
• Ability to work independently while contributing to a collaborative team environment.

Preferred Qualifications

• Front office and/or back office dental practice experience.

Benefits

• 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, BurnAlong memberships, 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.