Remote Claims Quality Auditor

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

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.