Jobs at LIBERTY Dental Plan

Maintain and support enterprise applications across environments by coordinating with vendors and teams, troubleshooting and resolving defects, managing deployments, performing code reviews, and supporting Azure/.NET/SQL-based web applications and secure file transfer (FTP/SFTP/FTPS/MOVEit). Drive continuous improvement, configuration management, and adoption of new technologies.

Manage daily AR activities including processing and applying payments, preparing monthly invoices, collections and aging monitoring, reconciliations, client billing inquiries, reserve calculations, audit support, and related accounting tasks.

Lead and execute encounter data submissions and regulatory reporting for Medicaid/Medicare. Perform hands-on SQL analysis, data validation, and audit support. Translate regulatory requirements into analytic solutions, mentor analysts, collaborate with IT/compliance/operations, and ensure accuracy, compliance, and readiness for regulatory examinations.

Lead the Grievance & Appeals department to ensure timely, compliant resolution of member and provider disputes. Oversee operations, regulatory compliance, audits, reporting, root-cause analysis, corrective actions, quality committees, regulatory filings, stakeholder communication, and continuous improvement while managing and developing staff.

Process dental claims, pre-authorizations, referrals, and benefit determinations within service level agreements. Adjudicate COB and orthodontic claims, perform high-volume data entry, maintain regulatory and procedural knowledge, collaborate across teams to resolve claim issues, and meet productivity and quality standards in a remote environment.

Support Medicaid and Medicare quality programs by managing projects, ensuring regulatory compliance, analyzing program data, reporting performance, coordinating cross-functional improvement efforts, and supporting accreditation and audit readiness.

Serve as liaison between business and IT to gather requirements, analyze systems, identify gaps, design and support solutions (RPA, APIs, web apps), document changes, troubleshoot issues, and drive continuous process improvement.

Lead and grow a systems engineering team to design, validate, and operate enterprise infrastructure. Own requirements management, architecture reviews, verification/validation, risk management, and cross-functional collaboration to ensure secure, reliable, and high-performing systems while driving process improvements and compliance.

Process dental claims, pre-authorizations, and referrals within SLAs; determine member benefits per plan guidelines; handle COB and orthodontic claims; perform high-volume data entry with accuracy; meet productivity and quality goals; stay current on regulations and support team projects.

Configure, test, and maintain claims and Utilization Management (UM) system logic. Analyze complex claim/UM scenarios, support benefit implementation, audit system rules and benefit setups, coordinate cross-functional implementations and member notifications, support Crystal Reports, and document policies and procedures.

Lead regional provider network recruitment, retention, contract review, fee schedule development, and provider relations. Manage and coach Provider Relations staff, coordinate cross-functional issue resolution, produce reporting, and implement performance and process improvements. Ensure contractual compliance and support utilization review and other committees; travel up to 50% and be based in Sacramento or Los Angeles.