Pharmacy Claims Auditor - 12 Months contract - Express Scripts Canada

The role of the Business Integrity team is to enhance the Express Scripts Canada (ESC) value proposition for customers to ensure the integrity of health claims while maintaining a network of providers through diligent review and education. The Auditor is responsible to conduct various types of audits across Canada to validate that providers are compliant with benefit plan design and professional practice regulations. The Auditor uses their analytical and investigative skills along with their practice and knowledge of provincial benefit coverage to identify trends observed from claim reviews and to ensure that the audit techniques evolve to remain effective in managing risk for ESC customers.

NOTE: This is a 12 months contract position with a possibility of extension.

ESSENTIAL FUNCTIONS:

• Perform claim verifications, desk and/or on-site audits

• Communicate with providers to gather information for audits, to educate on ...