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The objective of the Fraud Waste and Abuse program is to proactively detect and address risks in a timely manner that effectively manages the financial risk and reputation of Express Scripts Canada customers. As part of this team, the Operations Lead Analyst is responsible for administering operational efficiency processes that manage cost and optimize results, including financial data analysis and reporting. The Operations Lead Analyst presents opportunities and findings both verbally and in writing to key internal and external stakeholders, including coordinating and providing updates to private and public sector customers and other team(s) as necessary. The successful candidate will be involved in multiple projects and collaborate with department supervisors, managers and colleagues both in audit and in other ESC departments. This is an exciting opportunity for an adaptable candidate to gain experience and exposure to the administrative, financial and reporting operations of the audit department.

Key Responsibilities:

• Produce financial reports for clients and provide insights into trends

• Responsible for provider electronic withhold entries for audit recoveries for all benefits

• Monitor electronic withhold to satisfy timely audit recoveries

• Conduct quality review of audit reports for administrative accuracy and adherence to policies and timely submission to clients

• Review claim selections to ensure adherence to program guidelines.

• Collect and analyze quality assurance data for public sector client meetings and internal metrics

• Lead audit report review meetings with clients and prepare meeting minutes

• Ensure alignment and consistency of delivery of program between all benefits

• Identify emerging trends and create presentations for clients to support audit result meetings

• Work with both internal and external stakeholders to address client inquiries, gather, collect information, for deliverables

• Conduct monthly quality assurance review of staff time trackers

• Create and maintain forecasting tools for oversight on key performance indicators and emerging trends

• Oversee program training documents, SOPs, and working instructions. Ensure processes are mapped out, outlined and organized for team to utilize

• Maintain inventory of audit application scenarios to be used as a reference for team

• Lead quality-focused remedial training sessions for team. Assist managers with maintaining training records

• Identify, lead and manage special projects and program initiatives

• Continuously seek opportunities to create efficiencies within processes and drive value for the program

• Resolve non-routine issues escalated from other team members. Mentoring and developing team members using agile concepts.

• Tasks involve a degree of forward planning and anticipation of needs/issues

• Other duties as assigned

Qualifications:

• Bachelor’s degree or equivalent work experience

• Minimum of 4 years of related experience in Pharmacy and/or Dental Benefit Management, Group Insurance or Health Care Operations

• Highly proficient in Microsoft Access & Excel, and data warehousing applications

• Experience with compiling, manipulating or validating large pieces of data

• Ability to maintain electronic filing systems

• Display high levels of curiosity, integrity, tact and objective judgement

• Excellent organizational, planning and critical thinking skills

• Excellent verbal and written communication skills, including ability to present to clients and internal stakeholders

• Proven interpersonal skills and ability to work well with senior management and high-level external contacts handling sensitive or confidential information is critical

• Ability to work with minimum management oversight on multiple projects with competing priorities

• Ability to work a flexible schedule in high pressure environments with urgent deadlines

• Proven time and resource management skills; detail oriented with strong organizational abilities.

NOTE: Internal posting will be closed on April 8, 2024.

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: eschr2@express-scripts.com Do not email eschr2@express-scripts.com for an update on your application or to provide your resume as you will not receive a response.