Quality Audit Specialist

LIBERTY DENTAL PLAN CORPORATION•Tustin, CA

16d•$24 - $28•Remote

About The Position

The Quality Audit Specialist is responsible for auditing claims processing, specialty care referrals, group setup configurations, compliance reporting, benefit schedules, and provider fee schedules. This role requires strong analytical skills, sound judgment, and the ability to work independently while collaborating with cross-functional teams to identify opportunities for improvement and ensure operational excellence.

Requirements

Minimum of 4 years of experience in claims processing, claims auditing, and/or claims analysis.
Strong understanding of claims processing workflows and procedures.
Excellent attention to detail and commitment to accuracy.
Strong analytical and problem-solving skills.
Ability to prioritize work, manage multiple tasks, and meet deadlines independently.
Strong organizational and time management skills.
Excellent written and verbal communication skills.
Ability to maintain confidentiality and exercise sound judgment.
Proficiency in Microsoft Word and Excel.
Strong mathematical and data analysis capabilities.

Nice To Haves

Bachelor's degree or an equivalent combination of education and relevant work experience.
Experience within a Dental PPO or DHMO environment.
Experience auditing, reviewing, and analyzing claims data.
Experience identifying trends and making data-driven recommendations to improve performance and quality.

Responsibilities

Audit and analyze claims data to ensure processing accuracy and service level expectations are met.
Perform a high volume of audits to verify compliance with contractual, policy, and regulatory requirements.
Review claims processing activities and apply established policies and procedures to ensure accuracy.
Audit group setup configurations, including benefit schedules and frequencies, to confirm alignment with client contracts.
Review provider compensation schedules to ensure procedure codes and reimbursement amounts match contractual agreements.
Analyze audit results, identify trends, document findings, and communicate recommendations to appropriate departments.
Partner with operational teams to ensure identified issues are corrected accurately and timely.
Generate reports, monitor audit outcomes, and support process improvement initiatives.
Collaborate regularly with Claims and Utilization Management teams to improve quality and performance.
Manage assigned workloads and audit deadlines in a fast-paced environment.
Support a culture of teamwork, accountability, and continuous improvement.
Perform additional duties as assigned.

Benefits

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, BurnAlong memberships, 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.