Claims Referral Specialist II

Claims Referral Specialist II (Remote - East Coast)

Bring Your Dental Claims Expertise to a Mission-Driven Organization

About Liberty Dental Plan

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.

About the Role

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.

What You'll Do

• 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.

What You'll Bring

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.

What to Expect

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

Why Join Us?

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.

Apply Today

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.