Investigate healthcare claims within Express Scripts Canada's Fraud, Waste, and Abuse department, working hybrid from Mississauga with Canadian travel. Analyze evidence and provider practices.
As an Extended Healthcare Claims Auditor, you will validate provider compliance with benefit plans and provincial regulations. The 12-month contract combines claim reviews, desk and on-site audits, investigative analysis, and provider education. Your findings will support accurate recoveries, customer reporting, and evolving risk-management techniques. Healthcare experience and pharmacy education are relevant foundations.
Key Responsibilities:
- Conduct provider audits across Canada
- Communicate audit results and claim submission practices
- Review documentation for regulatory and plan compliance
- Complete post-audit activities and unbiased reporting
- Track analyses, recoveries, and department statistics
Requirements:
- Two to five years recent healthcare experience
- Graduate of accredited pharmacy education program
- RPhT designation preferred; audit experience an asset
- Ability to travel twenty to thirty percent
- Strong communication, organization, and problem-solving skills
Support healthcare integrity through provider investigations, audit reporting, claim adjustments, and risk analysis for Express Scripts Canada.
Healthcare Fraud Waste Abuse Auditor in Mississauga employer: Cigna Health and Life Insurance Company
Express Scripts Canada Pharmacy in Mississauga is an exceptional employer that prioritizes the well-being of its employees while fostering a collaborative and supportive work culture. With competitive pay, a comprehensive total rewards package, and ample opportunities for professional growth, you will be empowered to make a meaningful impact on patient care and contribute to better health outcomes for our members.
Contact Details:
Cigna Health and Life Insurance Company Recruitment Team
