Dental Claim Auditor

*Preference given to someone who has previous experience in processing practices of Dental claims for Group Benefit plans at a TPA and/or insurance company. *

Orion Audit Limited has been conducting Drug, Extended Health, Dental and Disability Group Benefits claims audits since 2005. We have quickly emerged as the industry leader in claims audits and have a reputation for bringing strong governance and accountability to benefit plans. Our clients include an expanding base of both Public and Private organizations located across Canada.

As a boutique firm, we strongly value individual contributions from each team member, providing autonomy in your technically skilled work. As a member of this specialized team, you can expect to be challenged in a meaningful way, allowing your creativity and passion for Dental Benefits to shine.

Role Summary

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 clients Group Benefits plans. Keeping up with key industry trends, new products, and processes is highly valued.

What You Will be Doing
- 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 This 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 fluctuating and unpredictable workload
- Strong research, problem-solving, and decision-making skills
- Demonstrated strong written and verbal communication skills

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

What We Bring to The Table

At Orion, we understand there are no shortcuts to any place worth going, which is why we recognize the dedication and unique contributions of our team members. Our success is largely attributed to our diverse team of specialists, one of the reasons we offer competitive salaries. Since compensation isn’t just focused on salary, we also provide:

- Flexibility to customize compensation, including vacation time, based on what matters to you most
- Flexible work hours, since life can still happen between 9-5
- Flexible work-from-home options, such as working remotely from home or cottage. Occasional travel to our Kleinburg office may also be required
- Comprehensive Health Benefits package, since a healthy employee is a happy one
- Retirement contributions: we believe in planning for your future as much as you do
- Allowances for continued learning and educational expenses
- Reimburse expenses such as your cell phone and reasonable office supplies
- Opportunity to design, create, and develop this role further
- Opportunities for growth and to take on progressively increasing responsibilities
- Be part of an encouraging, collaborative, and high-performing team

Orion Audit is part of the Navacord group of companies. Navacord is a leading insurance and risk management brokerage created to keep the Canadian entrepreneurial spirit alive. Led by a passionate and engaged partnership group, Navacord Broker Partners are committed to the success of their clients by delivering expert advice in an increasingly complex world which allows them to face the future with confidence.

BUILDING THE GREAT CANADIAN BROKERAGE

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