Claims Referral Specialist III

Job DetailsJob Location: Remote - Corp - Tustin, CA 92782Join Liberty Dental Plan and Make an Impact At Liberty Dental Plan, we are committed to improving oral health and delivering exceptional service to the members, providers, and communities we serve. We are seeking a highly experienced and detail-oriented Claims Referral Specialist III to join our team and play a critical role in ensuring the accurate and timely processing of dental claims, pre-authorizations, and referrals. This position is ideal for professionals who have advanced claims processing expertise, thrive in a fast-paced environment, and are passionate about delivering accuracy, quality, and outstanding service. About the Role The Claims Referral Specialist III is responsible for processing dental claims and/or pre-authorizations and referrals within established plan timelines while consistently meeting production and quality standards. As the most advanced level within the Claims Referral Specialist career path, this role requires the ability to process complex claims, referrals, and pre-authorizations across all lines of business, including specialized or high-priority client accounts. The ideal candidate is a self-starter with strong analytical skills, exceptional attention to detail, and a commitment to operational excellence. What You'll Do Process dental claims, pre-authorizations, and referrals accurately and within established service level agreements. Review and determine benefits in accordance with plan guidelines, policies, and regulatory requirements. Process claims involving Coordination of Benefits (COB), Orthodontics, and other complex claim types. Handle specialized client claims, referrals, and pre-authorizations requiring advanced knowledge and expertise. Perform high-volume data entry while maintaining accuracy and quality standards. Maintain current knowledge of service level agreements, state regulations, and departmental procedures. Meet or exceed productivity, quality, and turnaround time goals. Support a collaborative team environment and contribute to departmental success. Follow established policies, procedures, and safety protocols. Perform additional duties and special projects as assigned. What You'll Bring Required Qualifications High school diploma or GED. Minimum of one year of dental claims processing experience. Working knowledge of Microsoft Office, including Excel, Outlook, and Word. Ability to work independently and consistently meet performance expectations. Typing speed of at least 40 words per minute. Strong 10-key data entry skills. Excellent communication, customer service, and organizational skills. Strong attention to detail and ability to manage multiple priorities. Preferred Qualifications Registered Dental Assistant (RDA) certification. Front office and/or back office experience in a dental practice. Success in This Role Successful candidates will demonstrate: Advanced knowledge of dental claims, referrals, and pre-authorization processing. The ability to manage complex and specialized claims with accuracy and efficiency. Exceptional attention to detail and analytical thinking. A commitment to quality, productivity, and service excellence. Professionalism, dependability, and strong attendance. The ability to work effectively both independently and as part of a team. Strong problem-solving skills and the ability to adapt to changing priorities. Work Environment This position is performed primarily in an office environment and requires extended periods of sitting, typing, and computer work. Employees should be comfortable working with standard office equipment and maintaining productivity throughout the workday. Why Join Liberty Dental Plan? At Liberty Dental Plan, every team member plays an important role in helping members access quality dental care. We foster a collaborative, mission-driven culture that values accountability, integrity, innovation, and service excellence. Your expertise will directly contribute to creating positive experiences for our members and provider partners while supporting the organization's commitment to improving oral health outcomes. If you are an experienced dental claims professional looking to take your career to the next level with an organization dedicated to making a difference, we encourage you to apply today. Join Liberty Dental Plan and help deliver the exceptional service our members and providers depend on every day. Location Our employees are distributed in office locations in multiple markets across the United States. We are unable to hire or allow employees to work outside of the United States.   What Liberty Offers Happy, healthy employees enhance our ability to assist our members and contribute more actively to their communities. That’s why Liberty offers competitive and attractive benefit packages for our employees. We strive to care for employees in ways that promote wellness and productivity.   Our first-class benefits package supports employees and their dependents with: Competitive pay structure and savings options to help you reach your financial goals. Excellent 401(k) retirement benefits, including employer match, Roth IRA options, immediate vesting during the Safe Harbor period, and access to professional financial advice through Financial Engines. Affordable medical insurance, with low-cost premiums for employee-only coverage. Liberty subsidizes the cost for eligible dependents enrolled in the plan. 100% employer-paid dental coverage for employees and eligible dependents. Vision insurance with low-cost premiums for employee-only coverage and dependents. Company-paid basic life and AD&D insurance, equal to one times your base salary, with options to purchase additional supplemental coverage. Flexible Spending Accounts for healthcare 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, and gym discounts. Employee Assistance Program (EAP) to support mental health and well-being. Generous vacation and sick leave policies, with the ability to roll over unused time. 10 paid company holidays. Tuition reimbursement for eligible educational expenses. Remote or hybrid work options available for various positions.   Compensation In the spirit of pay transparency, the base salary range for this position is $22.00 - $27.00 an hour, not including fringe benefits or potential bonuses. At Liberty, your final base 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 current team members when making final compensation decisions.   Please note that the range listed represents the full base salary range for this role. Typically, offers are not made at the top of the range to allow for future salary growth.   Liberty Dental Plan commits to maintaining a work environment that acknowledges all individuals within the workplace and will continue to engage in practices that are inclusive of all backgrounds, experiences, and perspectives. We strive to have every person within the organization have a sense of belonging while encouraging individuals to unleash their full potential. Liberty will leverage diverse perspectives in building high performance teams and organizational culture.    Liberty Dental Plan will continue to strengthen and develop external partnerships by providing equitable health care access and improving population health in the communities we serve.    We comply with all applicable laws and regulations on non-discrimination in employment, recruitment, promotions, and transfers, as well as work authorization and employment eligibility verification requirements.   Sponsorship and Relocation Specifications Liberty Dental Plan is an Equal Opportunity Employer / VETS / Disabled. No relocation assistance or sponsorship available at this time.