Job Description

*Building Brighter Futures One Smile at a Time!*

The Senior Internal Auditor is responsible for assisting with all day-to-day audit functions including: auditing of claims processing, specialty care referrals, prior-authorizations, group set up, benefit plans, and system configuration as related to claims and estimates; providing support for compliance reporting, group and compliance audits from external entities; tracking external audits; staff training and calibration; and departmental reporting.

Job Summary Details

* Audit and analyze claims data to ensure processing accuracy and service levels are met at individual, group, and company-wide levels.
* Understand claims processing policies and procedures and other processes (prior authorizations and referrals), in order to perform audits.
* Review and validate group set up including benefit schedules and frequencies to ensure claims are processed accurately according to groups contract.
* Audit provider compensation schedules linked in the system to ensure that procedure codes and dollar amounts match up according to signed contracts.
* Analyze, document, and review audit results to identify trends and report to appropriate departments for training purposes.
* Follow up with appropriate departments to ensure necessary corrections are made timely.
* Maintain a safe and productive working environment following established protocols.
* Assist with the development of department policies and procedures.
* Participate in system enhancement discussions with management and IT Department
* Ensure interactions remain positive and professional with all persons with whom you interact in the course of your work both internally and externally.
* Other duties as assigned or determined appropriate.

*Education/Experience*


4 Year / Bachelors Degree, or equivalent combination of education and related work experience


4 yearsin claims processing, claims audit, and/or analyzing and reviewing claims data or prior authorizations / UM required; within the Dental PPO or DHMO environment highly preferred.


1yearprevious audit experience required.

*Specific Skills/Knowledge*

* Strong understanding of claims processing, preferably within dental the Dental PPO or DHMO environment
* Proficiency with Microsoft Word and Excel
* Strong analytical skills for reporting and trend analysis
* Ability to work independently and meet objectives
* Ability to be discreet and keep audit results confidential
* Detail-oriented
* Good math skills to calculate claims and audit results
* Ability to analyze complex claims information.
* Ability to set the example and promote teamwork amongst peers.
* Strong organizational and prioritization skills
* Strong written and oral communication skills
* Ability to define problems, collect relevant data, establish facts, and draw valid conclusions
* Ability to utilize resources available to research issues and follow through until resolved

*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 society. Thats why Liberty offers competitive and attractive benefit packages for their employees. We strive to care for employees in positive ways that promotes wellness and productive employees.

* Our first-class benefit package supports our employees and their dependents with:
* Competitive pay structure and saving options that help you reach your financial goals
* Excellent 401k retirement benefits available which includes employer match and ability to save via a Roth IRA, plus immediate vesting during Safe Harbor period and professional financial advice through Financial Engines!
* Medical insurance offered with low-cost premium for employee only coverage and Liberty subsidizes 50% of dependent coverage for eligible enrolled dependents.
* 100% employer paid dental coverage for employees and eligible dependents.
* 100% employer paid vision coverage for employee only coverage, low-cost premium for dependents!
* Company paid basic life and AD&D coverage; options to elect additional supplemental coverage.
* Long Term Disability coverage
* Expansive wellness program including companywide Get Active challenges and Burn-A-Long with option for gym discounts.
* Employee Assistance Program
* Generous vacation and sick leave with the ability to roll time over.
* 10 paid company holidays
* Tuition Reimbursement
* Remote or Hybrid options for various positions
* And so much more...

*Compensation*


In the spirit of pay transparency, we are excited to share the base hourly rate for this position is $22.00 - $28.25, exclusive of fringe benefits or potential bonuses. If you are hired at Liberty, your final base salary compensation will be determined based on factors such as geographic location, skills, education, and/or experience. In addition to those factors we believe in the importance of pay equity and consider internal equity of our current team members as a part of any, final offer. Please keep in mind that the range mentioned above is the full base salary range for the role. Hiring at the maximum of the range would not be typical in order to allow for future & continued 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.