# Bilingual Dental Claims Auditor **Company**: Express Scripts Canada **Location**: Mississauga or Montreal, ON **Work arrangement**: hybrid **Experience**: mid **Job type**: full-time **Salary**: $58,000 - $65,000 **Category**: Healthcare **Industry**: Healthcare **Apply**: https://cigna.wd5.myworkdayjobs.com/en-US/cignacareers/job/Montreal-QC/Bilingual-Dental-Claims-Auditor-Vrificateur-bilingue-en-soins-dentaires---Express-Scripts-Canada_26011520?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply **Canonical**: https://yubhub.co/jobs/job_43805775-f1a ## Description We are seeking a Bilingual Dental Claims Auditor to join our Fraud, Waste & Abuse team. The successful candidate will be responsible for conducting various types of audits across Canada to validate that providers are compliant with benefit plan design and professional practice regulations. Key Responsibilities: - Perform claim verifications, desk and/or on-site audits for Dental benefits - Communicate with providers to gather information for audits, to educate on claim submission practices and to respond to queries in regards to audit results - Assess provider documentation to ensure compliance with enrolment agreement, benefit plan design and provincial regulations - Calculate the adjustments required to correct claim transactions - Prepare, coordinate and travel to conduct on-site audit at the provider's location, and complete the post on-site audit activities - Compile and produce audit reports that are detailed and unbiased - Perform self and peer-review to ensure accuracy and quality of claim reviews - Track audit activity and summarize results of claim analysis and recoveries on a daily and/or monthly basis for department statistics for presentation to customers - Identify trends observed from claim reviews and provide recommendations for risk criteria changes and/or candidates for a desk or on-site audit - Recommend incremental and continuous ideas that will increase ability to prevent and manage risk that will bring the most value to customers - Respond to internal and external customer questions professionally, timely and accurately - Other duties and responsibilities as assigned What We're Looking For: - 2-5 years of recent experience in dental offices and knowledge of dental office software and dental procedure codes - Valid driver's license and ability to travel across Canada 20-30% of the time - Diploma in Dental Assisting or Dental Hygiene and valid practicing permit - Experience in data analysis, including financial and statistical data - Experience in report writing - In-depth knowledge of dental benefit plans, dental procedures, and reimbursement rules - Experience in auditing or investigation is an asset - Ability to handle confidential information - Excellent time management and organizational skills - Strong analytical and problem-solving skills, with ability to mediate difficult situations - Motivated, curious, and able to work independently with minimal supervision - Excellent interpersonal skills, with ability to work collaboratively with employees from other departments - Flexible, resourceful, and open to change - Strong interest in professional development and continuous learning - Excellent oral and written communication skills - Proficient in MS Office applications (Excel, Word, Outlook) - Bilingual (French and English) is essential - LOMA (Life Office Management Association) or HIAA (Health Insurance Association of America) certification is an asset ## Skills ### Required - Dental claims auditing - Data analysis - Report writing - Dental office software - Dental procedure codes - MS Office applications - Bilingual - French ### Nice to have - LOMA certification - HIAA certification - Auditing or investigation experience --- Source: [Apply at cigna.wd5.myworkdayjobs.com](https://cigna.wd5.myworkdayjobs.com/en-US/cignacareers/job/Montreal-QC/Bilingual-Dental-Claims-Auditor-Vrificateur-bilingue-en-soins-dentaires---Express-Scripts-Canada_26011520?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)