Quality Audit Specialist

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.

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

• 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.

• 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.

• Bachelor's degree or an equivalent combination of education and relevant work experience.
• Experience with in 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.

• 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.

At Liberty Dental Plan, quality matters. As a Quality Audit Specialist, you'll have the opportunity to…