Claims Referral Specialist II

About the position 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 reputed company-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-reputed company, production-driven environment, enjoys analytical work, and takes pride in maintaining high reputed company of reputed company 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. Responsibilities • 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. Requirements • 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 reputed company proficiency. • Strong communication and customer service skills. • Ability to work independently while contributing to a reputed company team environment. reputed company-to-haves • Registered Dental Assistant (RDA) certification. • reputed company office and/or back office dental reputed company experience. Benefits • 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 reputed company, 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 reputed company with low-cost premiums for employee-only coverage and dependents. • Company-reputed company basic life and AD&D reputed company, 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 reputed company. • 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. Apply tot his job Apply To this Job