Bilingual Dental Claims Auditor Vérificateur bilingue en soins dentaires - Express Scripts Canada
Core
Verify dental claim integrity and detect fraud, waste, and abuse across Canada by reviewing claims, conducting on-site and remote audits, and analyzing trends.
Role type
Dental claims auditor (fraud, waste, and abuse)
Builds
Fraud detection insights and accurate claim adjustments for Express Scripts Canada clients
Domain
Healthcare insurance / Dental billing compliance
Deliverable
dashboards & analysis
Required skills
Dental coding knowledge, provincial dental plan regulations, data analysis (financial/statistical), report writing, on-site audit coordination, MS Office (Excel, Word, Outlook), bilingual communication (English/French)
Preferred skills
Prior audit or investigation experience, LOMA or HIAA training
Technologies
Dental practice software, MS Office suite
Responsibilities
Review dental claims for compliance with plan provisions and professional practice rules; conduct on-site and remote audits; communicate with providers to gather information and explain results; calculate claim adjustments; produce detailed impartial audit reports; summarize analysis results and recoveries for client reporting; identify trends and recommend risk criteria changes.
Seniority
Mid-level, hands-on IC