Auditeur Télétravail - Montréal, QC, Canada - Cigna Health and Life Insurance Company

Description

Bilingual Dental Auditor-Express Scripts Canada page is loaded Bilingual Dental Auditor-Express Scripts Canada
Apply remote type Hybrid locations Montreal, QC Mississauga, ON time type Full time posted on Posted 4 Days Ago job requisition id The role of the Fraud, Waste and Abuse team is to enhance 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. The Dental Benefit 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. The Auditor uses their analytical and investigative skills along with their practice and knowledge of provincial benefit coverage to identify trends observed from claim reviews and to ensure that the audit techniques evolve to remain effective in managing risk for ESC customers.
Perform claim verifications, desk and/or on-site audits
Communicate with providers to gather information for audits, to educate on claim submission practices and to respond to queries in regards to audit results
Calculate the adjustments required to correct claim transactions
Prepare, coordinate and travel to conduct on-site audit at the provider's location, and complete the post on-site audit activities
Compile and produce audit reports that are detailed and unbiased
Perform self and peer-review to ensure accuracy and quality of claim reviews
Track audit activity and summarize results of claim analysis and recoveries on a daily and/or monthly basis for department statistics for presentation to customers
Identify trends observed from claim reviews and provide recommendations for risk criteria changes and/or candidates for a desk or on-site audit.
Recommend incremental and continuous ideas that will increase ability to prevent and manage risk that will bring the most value to customers
2-5 years recent experience in a dental office environment with working knowledge of dental software and fee codes
~ Valid driver's license and ability to travel in Canada, range of 20-30% of time
~ Graduate of post-secondary educational program either as a dental assistant or dental hygienist with a valid license
~ Bilingualism (French & English) is a must.
~ Experience in data analysis, financial and statistics.
~ Experience in report writing.
~ In-depth knowledge of dental benefits, reimbursement and dental regulations
~ Previous audit/investigation experience is an asset
~ Flexible, resourceful, with a mindset that embraces and champions change
~ Proficiency in MS Office (Excel, Word, Outlook).
~ Life Office Management Association (LOMA) or Health Insurance Association of America (HIAA) training would be an asset


Le vérificateur en soins dentaires est chargé d'effectuer différents types de vérifications partout au Canada afin de vérifier si les fournisseurs respectent les dispositions des régimes et les règles de pratique professionnelle. Le vérificateur utilise ses compétences en matière d'analyse et d'enquête ainsi que ses connaissances et son expérience en matière de couverture des soins de santé à l'échelle provinciale afin de déceler des tendances dans les demandes de règlement. Il s'assure également que les techniques de vérification évoluent afin de demeurer efficaces dans la gestion des risques auxquels les clients d'Express Scripts Canada sont exposés.
Réviser son propre travail ainsi que celui de ses collègues afin de s'assurer de l'exactitude des données et de la qualité de l'examen des demandes de règlement.
Effectuer un suivi des activités de vérification et résumer les résultats de l'analyse des demandes de règlement et des recouvrements sur une base quotidienne ou mensuelle afin d'établir des statistiques pour le Service de vérification en matière de fraude, de gaspillage et d'abus qui seront présentées aux clients.
Posséder de 2 à 5 années d'expérience récente en cabinets dentaires et connaître les logiciels utilisés par ces cabinets ainsi que les codes d'actes dentaires.
Être titulaire d'un diplôme d'assistant dentaire ou d'hygiéniste dentaire et d'un permis d'exercice valide.
Être bilingue (français et anglais) est essentiel.
Posséder de l'expérience en analyse de données, notamment de données financières et statistiques.
Posséder des connaissances approfondies des règles en matière de régimes de soins dentaires, d'actes dentaires et de remboursement.
Posséder de solides capacités de raisonnement et d'analyse, être en mesure de résoudre des problèmes et d'agir à titre de médiateur dans les situations difficiles.
Avoir un grand intérêt pour le perfectionnement et l'apprentissage continu.
Posséder des connaissances approfondies des applications de la suite MS Office (Excel, Word, Outlook).
Avoir suivi une formation des associations LOMA (Life Office Management Association) ou HIAA (Health Insurance Association of America) constitue un atout.
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.
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. 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.
By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.
If you require accommodation in completing the online application process, please email: -scripts.FWA Dental Auditor - 12 months contract - Express Scripts Canada
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remote type Hybrid locations Mississauga, ON time type Full time posted on Posted Today Doing something meaningful starts with a simple decision, a commitment to changing lives.
At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients.