Claims Referral Specialist I
About The Position
Liberty Dental Plan is seeking a detail-oriented Claims Referral Specialist I to support the daily processing of dental claims, pre-authorizations, and specialty referrals. The specialist reviews and processes claims and referral requests according to plan benefits, service level agreements (SLAs), and regulatory requirements. The role works with internal teams, providers, members, and other stakeholders to support accurate claim adjudication, timely referral processing, and effective service. This position is generally performed remotely and is primarily sedentary, involving extended periods of sitting, typing, and close-range visual work. It is a full-time, hourly, non-exempt position with a pay range of $20–$22 per hour. Final compensation depends on factors including geographic location, skills, education, and experience. Employees must be authorized to work in the United States and may not work outside the country.
Requirements
- High school diploma or GED.
- Minimum of one year of dental claims processing experience.
- Working knowledge of Microsoft Office, including Excel, Outlook, and Word.
- Strong organizational skills and attention to detail.
- Excellent communication and customer service skills.
- Ability to work independently and meet performance objectives.
- Ability to manage multiple priorities while maintaining accuracy and productivity.
- Minimum typing speed of 40 words per minute.
- 10-key proficiency by touch.
- Ability to understand and follow written and verbal instructions.
Nice To Haves
- Registered Dental Assistant (RDA) certification.
- Front office or back office dental office experience.
- Experience processing dental referrals, pre-authorizations, or treatment estimates.
- Familiarity with dental terminology, CDT coding, and benefit plans.
- Experience working in a managed care or dental insurance environment.
Responsibilities
- Process dental claims, pre-authorizations, and referral requests within established turnaround times and quality standards.
- Review claims and referrals for benefit eligibility and coverage determination.
- Accurately enter and maintain data within claims processing systems.
- Interpret plan benefits, policies, and procedures to ensure proper claim adjudication.
- Maintain current knowledge of company guidelines, service level agreements, and regulatory requirements.
- Research and resolve claim discrepancies, incomplete documentation, and processing issues.
- Communicate professionally with providers, members, and internal departments regarding claim or referral status, requirements, and resolutions.
- Meet or exceed established production and quality goals.
- Promote teamwork and collaborate effectively with colleagues across departments.
- Support process improvements and operational efficiency initiatives.
- Maintain confidentiality and comply with company policies and industry regulations.
- Perform other duties as assigned.
Benefits
- 401(k) retirement plan with employer match and Roth options.
- Affordable medical insurance.
- Employer-paid dental coverage for eligible employees and dependents.
- Vision insurance.
- Company-paid life and AD&D insurance.
- Flexible Spending Accounts (FSA).
- Voluntary accident, critical illness, and hospital indemnity coverage.
- Long-term disability coverage.
- Employee wellness programs and resources.
- Employee Assistance Program (EAP).
- Vacation and sick leave programs.
- Paid company holidays.
- Tuition reimbursement opportunities.
- Remote or hybrid work options for eligible positions.
- Savings options.
- Potential bonuses.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
