Claims Quality Assurance and Training Specialist

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Claims Quality Assurance and Training Specialist

Job Information
Author pmnationtalk
Date November 24, 2021
Deadline Open
Type Full Time
Company Express Scripts Canada
Location Toronto, ON
Category Operations
Client Express Scripts Canada
Contact Information
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Claims Quality Assurance and Training Specialist

Express Scripts Canada is looking for an analytical individual to perform quality assurance reviews on Dental, Medical Supplies and Equipment, Pharmacy, Vision Care and Mental Health claims within the Health Claims Administration Department.  A primary function of this role is to oversee the Quality Assurance of staff.  Using analytical and technical skills, the incumbent must be very detail oriented in identifying and reporting claims processing errors and initiating corrective as well as preventive actions.

The successful candidate will also provide training and guidance to existing and new team members. Working with leaders in the business, you will design effective training materials to facilitate classes and manage training-related projects, support the Claims Team goals of delivering high quality service and addressing customer needs.  This role will directly contribute to building high quality claims processing in a high-performance culture.


  • Audit a sampling of claims processed by each claim processors on daily basis
  • Compare each claim processed to the source document and identify deficient keying and actions that are inconsistent with the NIHB policies and procedures in the APM
  • Identify opportunities for process improvements and efficiencies
  • Prepare Quality Assurance reports for leadership team on a weekly basis or as requested
  • Responsible for preparing overall monthly claims accuracy report for Management team
  • Train all new processing staff for Dental, Medical Supplies and Equipment, Pharmacy, Vision Care and Mental Health claims processing
  • Provide training and support to existing claims processors
  • Review, track and respond to all quality assurance inquiries from internal and external sources
  • Communicate results of an audit with processors via one-on-one coaching and through team huddles
  • Ensure system and process changes are up to date
  • Update user manuals, Administration Processing Manual, which are used to document procedures and used as a reference tool for processors
  • Conduct trainee evaluations at three and six month’s intervals.  Evaluate performance based on quality results
  • Responsible for developing and delivering training plans to new and existing staff


  • Experience working within the NIHB program in an Operations role capacity
  • Experience in training or facilitation with small and large groups; strong presentation skills
  • Proven time management and organizational skills and ability to create multiple timelines and schedules
  • Analytical and problem solving skills with ability to identify trends and strategize for better solutions
  • Excellent verbal and written communication skills. Must be able to communicate effectively and confidently with team members and management.
  • Self-motivation, determination and ability to adapt in a dynamic work environment
  • Quick learner and ability to make decisions with minimal supervision
  • Advanced proficiency of Microsoft Office suit, specifically Excel
  • Numeracy and a strong aptitude for mathematics
  • Ability to work a flexible schedule in a fast paced work environment
  • The ability to speak and write in French is an asset

Internal application deadline – November 29, 2021

Express Scripts Canada is a Cigna company

Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

About Express Scripts Canada

Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada’s leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy™ services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.

It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation 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.

If you require accommodation in completing the online application process, please email: [email protected] Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.

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