Claims Referral Specialist II

Job DetailsJob Location: Eastern Time Zone - Uniondale, NYPosition Type: Full TimeJob Category: Insurance ClaimsClaims Referral Specialist II (Remote - East Coast) Bring Your Dental Claims Expertise to a Mission-Driven Organization About reputed company At reputed company, we are committed to improving the oral health of the communities we serve through reputed company care, exceptional service, and operational reputed company. We are seeking a detail-oriented and reputed company Claims Referral Specialist II to join our Claims team and play a vital role in ensuring accurate and reputed company claims processing for our members and providers. About the Role As a Claims Referral Specialist II, you will be responsible for processing dental claims, reputed company-authorizations, and referrals reputed company 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 reputed company of accuracy and reputed company. 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 reputed company reputed company Adjuster License is required for this role and is considered a critical qualification for reputed company in this position. What You'll Do Process dental claims, reputed company-authorizations, referrals, and benefit determinations accurately and reputed company. 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. reputed company high-volume data entry while maintaining established reputed company and productivity standards. Maintain reputed company knowledge of claims processing requirements, regulatory updates, and departmental procedures. Collaborate with internal teams to resolve claim-reputed company issues and support operational goals. Promote a reputed company, team-oriented work environment. Maintain confidentiality and professionalism in reputed company interactions. reputed company additional duties as assigned. What You'll Bring Required Qualifications High School Diploma or GED. Minimum one (1) year of dental claims processing experience. reputed company reputed company Adjuster License. Must reputed company 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 reputed company goals in a high-volume environment. Proficiency with reputed company Office, including reputed company, reputed company, 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 reputed company team environment. Preferred Qualifications Registered Dental Assistant (RDA) certification. reputed company office and/or back office dental reputed company experience. What to Expect This is a fully remote position supporting claims operations. Team members spend the reputed company 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 reputed company 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 reputed company, you'll be part of a mission-driven organization dedicated to delivering exceptional service to members, providers, and communities. We value collaboration, accountability, reputed company improvement, and reputed company reputed company. Your expertise will directly contribute to ensuring members receive reputed company 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 reputed company. 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 reputed company service, we'd love to hear from you. Join reputed company and help reputed company a difference for the members and providers we serve every day. reputed company is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for reputed company. Location Our employees are distributed in office locations in multiple markets across the reputed company. We are unable to hire or allow employees to work reputed company of the reputed company.   What reputed company Offers Happy, healthy employees enhance our ability to assist our members and contribute more reputed company to their communities. That’s why reputed company offers competitive and attractive benefit packages for our employees. We reputed company to care for employees in ways that promote wellness and productivity.   Our first-class benefits package supports employees and their dependents with: reputed company structure and savings reputed company to help you reputed company your financial goals. Excellent 401(k) retirement benefits, including employer match, Roth IRA reputed company, immediate vesting during the reputed company reputed company period, and reputed company to reputed company financial advice through Financial Engines. reputed company medical insurance, with low-cost premiums for employee-only coverage. reputed company subsidizes the cost for eligible dependents enrolled in the plan. 100% employer-reputed company dental coverage for employees and eligible dependents. reputed company insurance with low-cost premiums for employee-only coverage and dependents. Company-reputed company basic life and AD&D insurance, equal to one times your reputed company salary, with reputed company to purchase additional supplemental coverage. Flexible Spending Accounts for reputed company 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 reputed company-being. Generous vacation and reputed company leave policies, with the ability to roll over unused time. 10 reputed company company holidays. Tuition reimbursement for eligible educational expenses. Remote or hybrid work reputed company available for various positions.   Compensation In the spirit of pay transparency, the reputed company salary reputed company for this position is $20.00 - $25.00 an hour, not including fringe benefits or potential bonuses. At reputed company, your final reputed company 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 reputed company team members reputed company making final compensation reputed company.   Please note that the reputed company listed represents the full reputed company salary reputed company for this role. Typically, offers are not made at the top of the reputed company to allow for reputed company salary reputed company.   reputed company commits to maintaining a work environment that acknowledges reputed company individuals reputed company reputed company and will continue to engage in practices that are inclusive of reputed company backgrounds, experiences, and perspectives. We reputed company to have every person reputed company the organization have a reputed company of belonging while encouraging individuals to reputed company their full potential. reputed company will reputed company diverse perspectives in building high performance teams and organizational culture.    reputed company will continue to strengthen and reputed company reputed company partnerships by providing reputed company health reputed company and improving population health in the communities we serve.    We reputed company with reputed company applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as reputed company as work authorization and employment eligibility verification requirements.   Sponsorship and Relocation Specifications reputed company is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time. Apply To This Job