Pharmacy Claims Auditor, 12 Months Contract - Express Scripts Canada

Express Scripts Canada

Mississauga, Canada
$30.75 to $33.00 ph
Hybrid
Pharmacy claims verification
Provider compliance assessment
Claim transaction adjustments
Express Scripts Canada is seeking a Pharmacy Claims Auditor for a 12-month contract role in Mississauga, focusing on the integrity of health claims through audits and provider compliance. The position requires expertise in pharmacy operations and offers competitive compensation, career development, and a collaborative culture

Job Summary

  • 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.
  • Perform claim verifications, desk and/or on-site audits, communicate with providers, and assess provider documentation to ensure compliance.
  • Identify trends observed from claim reviews and provide recommendations for risk criteria changes and/or candidates for a desk or on-site audit.

Matching Summary

Match Score: 75

Express Scripts Canada is seeking a Pharmacy Claims Auditor for a 12-month contract role in Mississauga, focusing on the integrity of health claims through audits and provider compliance. The position requires expertise in pharmacy operations and offers competitive compensation, career development, and a collaborative culture.

Salary

$30.75 to $33.00 per hour

Skills & Requirements

Must-have

  • Pharmacy claims verification
  • Provider compliance assessment
  • Claim transaction adjustments
  • Audit report compilation
  • Trend identification and recommendations

Nice-to-have

  • Continuous improvement ideas
  • Professional and timely customer response
  • Embraces and champions change

Key Requirements

  • 2-5 years retail pharmacy experience
  • Graduate of accredited pharmacy program
  • RPhT designation preferred
  • In-depth knowledge of pharmacy benefits
  • Previous audit/investigation experience
  • Valid driver's license
  • Ability to travel 5-15% in Canada
  • Proficiency in MS Office

Work Rights

Enhanced Reliability Clearance required

Tailored Resume

Cover Letter