Claims Referral Specialist II

At Liberty Dental Plan, we are committed to improving the oral health of the communities we serve through quality care, exceptional service, and operational excellence. We are seeking a detail-oriented and experienced Claims Referral Specialist II to join our Claims team and play a vital role in ensuring accurate and timely claims processing for our members and providers.

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.

The successful candidate will bring strong dental claims knowledge, experience with Coordination of Benefits (COB) and Orthodontic claims processing, and the ability to collaborate effectively across departments while working independently in a remote setting. A Valid New York Adjuster License is required for this role and is considered a critical qualification for success in this position.

• 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.

Required Qualifications

• High School Diploma or GED.
• Minimum one (1) year of dental claims processing experience.
• Valid New York Adjuster License.
• Must reside in an East Coast 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

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

This is a fully remote position supporting claims operations. Team members spend the majority of their day reviewing and processing claims, working extensively with computer systems, and maintaining productivity and accuracy standards. Successful candidates are comfortable with repetitive, detail-oriented work and can consistently meet production and quality expectations.

You will regularly collaborate with teams across the organization, including:

• Claims Coordinators
• Provider Relations
• Provider Data Management
• Eligibility
• Clinical Services
• Member Services
• General & Administrative Teams

At Liberty Dental Plan, you'll be part of a mission-driven organization dedicated to delivering exceptional service to members, providers, and communities. We value collaboration, accountability, continuous improvement, and professional growth. Your expertise will directly contribute to ensuring members receive timely and accurate claims processing and support.

Physical & Work Environment

• Remote work environment.
• Primarily sedentary position requiring extended periods of sitting and computer use.
• Frequent data entry and screen time throughout the workday.
• Regular attendance and punctuality are essential.

If you have dental claims processing experience, a strong attention to detail, and a passion for delivering quality service, we'd love to hear from you. Join Liberty Dental Plan and help make a difference for the members and providers we serve every day.

Liberty Dental Plan is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.

Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.

• 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.

In the spirit of pay transparency, the base salary range for this position is $20.00 - $25.00 an hour, 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. We are committed to pay equity and also consider the internal equity of our current team members when making final compensation decisions.

Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.

Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture. 

Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve. 

We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.

Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled.

No relocation assistance or sponsorship available at this time.