Medical Claim jobs

WHY THIS ROLE MATTERS:

To conduct high-quality and detailed Dental Claim Audits on behalf of our clients. This includes analyzing dental claims data, detecting and evaluating patterns, trends, and anomalies, and turning them into meaningful insights and recommendations for our clients through formal written reports and presentations.

A component of this role includes supporting our consulting team as a technical resource. Conducting technical reviews, insights, and recommendations for the dental portion of our client's Group Benefits plans. Keeping up with key industry trends, new products, and processes is highly valued.

WHAT YOU’LL BE RESPONSIBLE FOR:

• Conduct high-quality, detailed Dental claim audits; evaluate adjudication processes, error rate, test plan eligibility, and adherence to the insurance contracts
• Review, interpret, and summarize plan designs from insurance contracts
• Analyze dental claim data and effectively detect and evaluate patterns, trends, and anomalies
• Identify opportunities, solutions, and recommendations to improve claims administrative processes with a focus on cost savings and risk management
• Prepare written reports; technical writing outlining observations and findings of claim audits
• Participate in the preparation and presentation of audit insights, findings, and recommendations to current or prospective clients and to generate new business opportunities

WHAT YOU BRING TO THE ROLE:

• Demonstrated knowledge and experience of Group Benefits dental plans and clinical experience within the dental industry
• Five to ten years of experience in processing practices of dental claims for Group Benefit plans at a TPA and/or insurance company
• Strong working knowledge of Provincial Suggested Fee Guides
• Solid background and familiarity with:
• Industry best practices
• Coordination of benefits
• Internal audit processes and fraud detection
• Dental plan design
• Dental utilization review
• Results oriented; ability to balance multiple priorities
• Comfortable speaking/presenting information in a group setting
• Ability to manage a fluctuating and unpredictable workload
• Strong research, problem-solving, and decision-making skills
• Proficient in computer applications (Word, Excel, Outlook)
• Demonstrated strong written and verbal communication skills

Assets

• Clinical experience working as a dental assistant, or dental hygienist
• Experience in Group Benefits risk management, including fraud detection and prevention strategies
• Consulting and/or underwriting experience

WHAT WE OFFER:

• Health and Dental Benefits
• RRSP Match Program
• Hybrid Work Environment
• Paid Vacation
• TimeEducational
• Reimbursement
• Expense Reimbursement

This is for an existing position.

Navacord DOES NOT

utilize artificial intelligence in the screening, assessment, or selection of applicants for this position.

Navacord is actively committed to support diversity, equity, and inclusion. We serve and recognize and respect human differences and similarities. We value the diversity of people and actively encourage women, indigenous peoples, members of visible minorities, people with disabilities, and lesbian, gay, bisexual, transgender, and queer (LGBTQ2+) persons to apply. We are committed to providing accommodation upon request for applicants and employees with disabilities. If you require accommodation, we will work with you to meet your needs.

Job Type: Full-time

Pay: $70,000.00-$85,000.00 per year

Benefits:

• Dental care
• Disability insurance
• Employee assistance program
• Extended health care
• Life insurance
• Work from home

Flexible language requirement:

• French not required

Work Location: Hybrid remote in Kleinburg, ON