Claims & System Auditor

Job Summary

Performs claims system, staff, and procedural audits to comply with DDPA guidelines and processes. Develops reports and provides staff training to maintain compliance.

Primary Job Responsibilities

• Performs system audits of processing policies to ensure implementation of DDPA and company established guidelines are appropriate. Documents and reports problems, exceptions, or opportunities for improvements to claims department and other departments as directed.
• Performs staff audits of data entry, adjustments and claims worklist transactions and compiles monthly results and reports for the Claims Manager.
• Performs staff audits of customer service claims processed and compiles monthly results and reports for the Customer Service Manager, team lead and Claims Manager.
• Participates in the evaluation and improvement of audit criteria and procedures, documentation, manuals, and records and assists in the tracking and reporting of departmental dashboard elements.
• Maintains required production and audit standards as established by the department and contributes to the accomplishment of team goals.
• Provides dental expertise and/or interpretation of dental policies, procedure codes, and processing guidelines to internal and external contacts, as needed.
• Provides support within the Claims Department in interpreting claims related issues; assists mailroom staff, as needed; serves as backup to other team members within department.

Performs other related assigned duties as necessary to complete the Primary Job Responsibilities as described above

Minimum Qualifications

Position requires a high school diploma or equivalent and three to five years' experience working in an audit environment or claims. Associate degree, technical, vocational, or business school degree is preferred. Will accept any suitable combination of education, training, or experience.

Position requires advanced knowledge of claim processing; knowledge of word processing and spreadsheet applications; strong verbal and written communication skills, analytical skills, and organizational skills; the ability to work independently and as part of a team; and the ability to resolve problems using independent judgement.

Delta Dental of Kentucky, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, or veteran status.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance
• Work from home

Physical setting:

• Office

Schedule:

• 8 hour shift
• Monday to Friday
• Overtime

Supplemental pay types:

• Bonus pay

Experience:

• claims: 1 year (Preferred)
• auditing: 1 year (Preferred)

Work Location: Hybrid remote in Louisville, KY 40223