Claims Referral Specialist II

This is a fully remote position, open to applicants in New York.

📋 Description

• Accurately and efficiently process dental claims, pre-authorizations, referrals, and benefit determinations.

• Review and adjudicate claims in accordance with plan guidelines, state regulations, and service level agreements.

• Handle Coordination of Benefits (COB) and Orthodontic claims processing.

• Execute high-volume data entry while upholding quality and productivity standards.

• Stay updated on claims-processing requirements, regulatory changes, and departmental procedures.

• Work collaboratively with internal teams to address claim-related concerns and support operational objectives.

• Uphold confidentiality and professionalism at all times.

• Regularly engage with Claims Coordinators, Provider Relations, Provider Data Management, Eligibility, Clinical Services, Member Services, and General & Administrative teams.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• High School Diploma or GED is required.

• A minimum of one (1) year of experience in dental claims processing is necessary.

• Possession of a valid New York Adjuster License or the ability to acquire one within the first 90 days of employment.

• Candidates must reside in a state within the Eastern Time Zone.

• Experience in processing Coordination of Benefits (COB) and Orthodontic claims is essential.

• Strong analytical and problem-solving capabilities are a must.

• Ability to achieve production and quality targets in a high-volume setting.

• Proficiency with Microsoft Office applications, including Excel, Outlook, and Word.

• A typing speed of at least 40 words per minute is required.

• Proficiency in 10-key by touch is essential.

• Excellent communication and customer service skills are necessary.

• Ability to work autonomously while also contributing to a team environment.

• Registered Dental Assistant (RDA) certification is preferred.

• Experience in front office and/or back office dental practice is preferred.

• Candidates must work within the United States; relocation assistance or sponsorship is not available.

🏝️ Benefits

• Competitive pay structure with savings options available.

• 401(k) retirement benefits, including employer matching contributions.

• Options for Roth IRA contributions.

• Immediate vesting during the Safe Harbor period.

• Access to professional financial advice through Financial Engines.

• Affordable medical insurance plans.

• 100% employer-paid dental coverage for employees and eligible dependents.

• Vision insurance included.

• Basic life and AD&D insurance fully covered by the company.

• Opportunities to purchase additional supplemental coverage.

• Flexible Spending Accounts available for healthcare and dependent care expenses.

• Voluntary accident, critical illness, and hospital indemnity insurance options.

• Long-term disability coverage provided.

• Comprehensive wellness programs, including company-wide wellness challenges, BurnAlong memberships, and gym discounts.

• Employee Assistance Program (EAP) available.

• Generous policies for vacation and sick leave, with the ability to roll over unused time.

• Ten paid company holidays each year.

• Tuition reimbursement offered for eligible educational expenses.

• Remote or hybrid work options are available for various positions.

• Potential bonuses are also available.