Express Scripts Canada has an exciting opportunity for a Dentist who is looking to expand their career to use their analytical and investigative skills along with their practice and knowledge of benefit coverage. This part-time role in the Business Integrity team enhances 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.
Review provider claims reports to identify abnormal or inconsistent claims submissions
Perform on-site audits at the provider’s location in Canada
Review & summarize findings from provider chart/clinical notes, radiographs, lab bills, etc.
Review audit reports for quality, accuracy, and proper audit application
Provide clinical opinion to support audit specialists
Participate as required in peer reviews with external clients
Consult with internal and external stakeholders regarding audit activities
Continuously review and provide recommendations regarding claims verification risk criteria
Minimum of 5 years of recent and demonstrated experience within a dental office environment
Current registration with a provincial college
Ability to manage confidential information
Strong focus on quality and accuracy
Detail-oriented with proven high-level oral and written communication skills
Demonstrates and applies integrity in all aspects of work
Excellent time management and organizational skills
Knowledge of Microsoft Office software (Word, Excel and PowerPoint)
Bilingualism (French & English) an asset.
About Express Scripts Canada
Express Scripts Canada, a registered business name of ESI Canada, an Ontario partnership indirectly controlled by Express Scripts, Inc. (Nasdaq: ESRX), is one of Canada’s leading providers of health benefits management services. From its corporate headquarters in Mississauga, Ontario, just outside Toronto, Express Scripts Canada provides a full range of integrated pharmacy benefit management (PBM) services to insurers, third-party administrators, plan sponsors and the public sector, including health-claims adjudication and processing services, Home Delivery Pharmacy Services, benefit-design consultation, drug-utilization review, formulary management, and medical and drug-data analysis services, to better facilitate the best possible health outcomes at the lowest possible cost.
It will be a condition of employment that the successful candidate receives the Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation in order to receive Clearance if required.
We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.
We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.
We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.
Thank you for your interest in this position however, only qualified candidates will be contacted for an interview. No telephone calls please.