Claims Referral Specialist II

Job Location:

Eastern Time Zone
- Uniondale, NY, Position Type:
Full Time, Salary Range:
Undisclosed, Job Category:
Insurance Claims, Claims Referral Specialist II (Remote
- Eastern Time Zone State)

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 or ability to obtain one within the 1st 90 days of hire, 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.

• 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.

• 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.

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.

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…