Claims Referral Specialist I

Join Liberty Dental Plan as a Claims Referral Specialist I and put your Claims Referral skills to work supporting accurate and efficient claims operations.

About the Role

Liberty Dental Plan is seeking a detail-oriented Claims Referral Specialist I to support the daily processing of dental claims, pre-authorizations, and specialty referrals. In this role, you will be responsible for reviewing and processing claims and referral requests in accordance with plan benefits, service level agreements (SLAs), and regulatory requirements.

Working closely with internal teams, providers, and other stakeholders, you will play an important role in ensuring accurate claim adjudication, timely referral processing, and exceptional service to our members and provider partners.

Pay Range: $20-$22 per hour
Position Type: Hourly, Non-Exempt

What You'll Do

• Process dental claims, pre-authorizations, and referral requests within established turnaround times and quality standards.
• Review claims and referrals for benefit eligibility and coverage determination.
• Accurately enter and maintain data within claims processing systems.
• Interpret plan benefits, policies, and procedures to ensure proper claim adjudication.
• Maintain current knowledge of company guidelines, service level agreements, and regulatory requirements.
• Research and resolve claim discrepancies, incomplete documentation, and processing issues.
• Communicate professionally with providers, members, and internal departments regarding claim or referral status, requirements, and resolutions.
• Meet or exceed established production and quality goals.
• Promote teamwork and collaborate effectively with colleagues across departments.
• Support process improvements and operational efficiency initiatives.
• Maintain confidentiality and compliance with company policies and industry regulations.
• Perform other duties as assigned.