The successful candidate will be responsible for conducting various types of audits across Canada to validate that providers are compliant with benefit plan design and professional practice regulations.

Key Responsibilities:

• Perform claim verifications, desk and/or on-site audits for Dental benefits
• Communicate with providers to gather information for audits, to educate on claim submission practices and to respond to queries in regards to audit results
• Assess provider documentation to ensure compliance with enrolment agreement, benefit plan design and provincial regulations
• Calculate the adjustments required to correct claim transactions
• Prepare, coordinate and travel to conduct on-site audit at the provider's location, and complete the post on-site audit activities
• Compile and produce audit reports that are detailed and unbiased
• Perform self and peer-review to ensure accuracy and quality of claim reviews
• Track audit activity and summarize results of claim analysis and recoveries on a daily and/or monthly basis for department statistics for presentation to customers
• Identify trends observed from claim reviews and provide recommendations for risk criteria changes and/or candidates for a desk or on-site audit
• Recommend incremental and continuous ideas that will increase ability to prevent and manage risk that will bring the most value to customers
• Respond to internal and external customer questions professionally, timely and accurately
• Other duties and responsibilities as assigned

What We're Looking For:

• 2-5 years of recent experience in dental offices and knowledge of dental office software and dental procedure codes
• Valid driver's license and ability to travel across Canada 20-30% of the time
• Diploma in Dental Assisting or Dental Hygiene and valid practicing permit
• Experience in data analysis, including financial and statistical data
• Experience in report writing
• In-depth knowledge of dental benefit plans, dental procedures, and reimbursement rules
• Experience in auditing or investigation is an asset
• Ability to handle confidential information
• Excellent time management and organizational skills
• Strong analytical and problem-solving skills, with ability to mediate difficult situations
• Motivated, curious, and able to work independently with minimal supervision
• Excellent interpersonal skills, with ability to work collaboratively with employees from other departments
• Flexible, resourceful, and open to change
• Strong interest in professional development and continuous learning
• Excellent oral and written communication skills
• Proficient in MS Office applications (Excel, Word, Outlook)
• Bilingual (French and English) is essential
• LOMA (Life Office Management Association) or HIAA (Health Insurance Association of America) certification is an asset

Job Data by YubHub.