Bilingual environmental auditor supporting compliance and management - system audits for BluMetric’s water technology and engineering firm. Conducting site assessments and reporting across Canada, especially Quebec.
About the role
- Bilingual dental claims auditor reviewing healthcare claims and provider compliance for Express Scripts Canada, a Canadian health benefits manager. Conducting desk and on-site audits across Canada.
Responsibilities
- Perform claim verifications and desk and/or on-site audits for dental, vision, mental health, and other healthcare benefits as needed
- Communicate with providers to gather information for audits, educate them on claim submission practices, and respond to questions about audit results
- Assess provider documentation for compliance with enrollment agreements, benefit plan design, and provincial regulations
- Calculate adjustments required to correct claim transactions
- Prepare, coordinate, and travel to on-site audits at provider locations, and complete post-audit activities
- Compile and produce detailed, unbiased audit reports
- Perform self- and peer reviews to ensure the accuracy and quality of claim reviews
- Track audit activity and summarize claim analysis and recovery results for department statistics and customer presentations
- Identify trends and recommend changes to risk criteria or candidates for desk or on-site audits
- Recommend continuous improvements to prevent and manage risk and increase customer value
- Respond to internal and external customer questions professionally, promptly, and accurately
- Perform other assigned duties
Requirements
- Graduate of a post-secondary educational program as a dental assistant or dental hygienist, with a valid license
- 2–5 years of recent experience in a dental office environment, with working knowledge of dental software and fee codes
- Valid driver’s license and ability to travel within Canada approximately 20–30% of the time
- In-depth knowledge of dental benefits, reimbursement, and dental regulations
- Previous audit or investigation experience is an asset
- Ability to manage confidential information
- Effective time-management and organizational skills
- Strong critical-thinking skills, with the ability to analyze, problem-solve, and mediate difficult situations
- Self-motivated, curious, and capable of working independently with minimal supervision
- Strong interpersonal skills; a team player with the ability to work cross-functionally with other departments
- Flexible and resourceful, with a mindset that embraces and champions change
- Ability to manage high-priority tasks in a fast-paced environment
- Ability to research and communicate findings effectively
- Passion for professional development and continuous learning
- Excellent verbal and written communication skills
- Proficiency in MS Office, including Excel, Word, and Outlook
- Bilingualism in French and English is required
- LOMA or HIAA training is an asset
- Successful completion of reference checks and background verification
- Enhanced Reliability Status clearance from the federal government is a condition of employment
Benefits
- Competitive compensation, benefits, and pension plan
- Career development and advancement opportunities
- A culture that celebrates innovation and collaboration
- Flexible work options and wellness programs
- A positive work environment built on strong corporate values, integrity, mutual respect, collaboration, passion, service, and alignment
- Accommodation for people with disabilities
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