Claims Referral Specialist II

This a Full Remote job, the offer is available from: California (USA), reputed company (USA) Claims 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. reputed company • 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 reputed company 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. This offer from "reputed company" has been enriched by reputed company.com and got a 75% reputed company score. Apply tot his job Apply To this Job