Quality Audit Specialist

Paycom; Tustin (CA); Hybrid; USD 33,000 - 39,000; Full time

Benefits offered by this job

Competitive pay

401(k) retirement benefits

Dental coverage

Vision insurance

Paid time off

Job summary

Liberty Dental Plan is seeking a Quality Audit Specialist to audit claims processing, referrals, and configurations, ensuring accuracy and compliance. The role supports regulatory standards and quality outcomes while collaborating with cross-functional teams in a remote-capable setup.

The ideal candidate will have strong analytical and communication skills, with experience in claims auditing and data analysis, and the ability to work independently in a fast-paced environment.

Qualifications

• Minimum of 4 years in claims processing, auditing, or analysis.
• Strong understanding of claims workflows and procedures.
• Excellent attention to detail and accuracy.

Responsibilities

• Audit claims data to ensure processing accuracy and service levels.
• Perform high-volume audits to verify compliance with contracts and policies.
• Review processing activities and apply policies for accuracy.
• Audit group setups and benefit schedules for alignment with contracts.
• Review provider compensation schedules for code and reimbursement accuracy.
• Analyze results, identify trends, document findings, and share recommendations.
• Partner with operations to correct issues accurately and timely.
• Generate reports, monitor outcomes, and support process improvements.
• Collaborate with Claims and Utilization Management teams to improve quality.

Skills

Claims auditing

Claims analysis

Attention to detail

Analytical skills

Time management

Communication skills

MS Word & Excel

Education

Bachelor's degree or equivalent

Job description

Job Details: Job Location: Remote - Corp - Tustin, CA 92782, Position Type: Full Time, Job Category: Compliance & Audit,

Make an Impact Through Accuracy, Analysis, and Continuous Improvement

Are you a detail-oriented claims professional who thrives on identifying trends, ensuring compliance, and improving operational quality? Join Liberty Dental Plan as a Quality Audit Specialist and play a vital role in maintaining the accuracy and integrity of our claims operations. Your expertise will directly support quality outcomes, regulatory compliance, and exceptional service for the members and clients we serve.

About the Role

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.

Work Arrangement: Remote

Pay Range: $24.00 - $28.00 per hour

What You'll Do

• 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.

What You'll Bring

Required Qualifications

• 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.

Preferred Qualifications

• 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.

What Success Looks Like

• Delivering accurate and timely audits that support organizational quality standards.
• Identifying meaningful trends and opportunities for process improvement.
• Maintaining compliance with contractual and policy requirements.
• Building effective partnerships across departments.
• Consistently meeting productivity and audit deadlines while maintaining a high level of accuracy.

Why Join Liberty Dental Plan?

At Liberty Dental Plan, quality matters. As a Quality Audit Specialist, you'll have the opportunity to make a measurable impact on operational excellence while working with a collaborative team dedicated to delivering outstanding service. If you enjoy analyzing data, solving problems, and ensuring accuracy, this is an excellent opportunity to grow your career in a remote environment where your expertise is valued.

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.

• Competitive pay structure and savings optionsto 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 coveragefor employees and eligible dependents.
• Vision insurancewith 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 Accountsfor 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 leavepolicies, with the ability to roll over unused time.
• 10 paid company holidays.
• Tuition reimbursementfor eligible educational expenses.
• Remote or hybrid work optionsavailable for various positions.

Compensation

In the spirit of pay transparency, the base salary range for this position is $24.00-$28.00 hourly, 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.