- Perform claim verifications, desk and/or on-site audits
- Communicate with providers regarding audit results, educate them on claim submission practices, and respond to queries
- Evaluate provider documentation to ensure compliance with ESC's provider agreement, benefit plan design, and provincial legislation
- Calculate adjustments required to correct claim transactions
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Pharmacy Claims Auditor - Mississauga - The Cigna Group
Description
The role of the Business Integrity team is to enhance the Express Scripts Canada value proposition for customers to ensure the integrity of health claims while maintaining a network of providers through diligent review and education. The Auditor is responsible for conducting various types of audits across Canada to validate that providers are compliant with benefit plan design and professional practice regulations.
Key Responsibilities:
Auditors use analytical skills along with knowledge of pharmacy software and provincial benefit coverage to identify trends observed from claim reviews. They also evolve audit techniques remain effective in managing risk for ESC customers.
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Sr. Tax Consultant
Only for registered members Mississauga, ON, CA
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Bookkeeper
Only for registered members Mississauga, Ontario
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Quality Assurance Manager
Only for registered members Mississauga, Ontario
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Accounts Payable
Only for registered members Mississauga
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Bookkeeper
Only for registered members Mississauga
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Manager – Finance
Only for registered members Mississauga
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Risk Management Advisor
Full time Only for registered members Mississauga
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Quality Assurance Manager
Only for registered members Mississauga
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Quality Return Supervisor (AR2012-5)
Only for registered members Mississauga, ON LT W
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Director of Finance
Only for registered members Etobicoke
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Business Administrator
Only for registered members Etobicoke, ON
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Junior Analyst, Program Finance
Only for registered members Brampton, ON
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Vendor Payment Auditor II
Full time Only for registered members Oakville
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Junior Analyst, Program Finance
Only for registered members Brampton
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Vendor Payment Auditor II
Only for registered members Oakville, Ontario
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Vendor Payment Auditor II
Only for registered members Oakville, ON
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Vendor Payment Auditor II
Only for registered members Oakville, ON
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Junior Analyst, Program Finance
Only for registered members Brampton, Ontario
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Tax Analyst/Accountant
Full time Only for registered members Toronto
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Clinical Provider Auditor II
Full time Only for registered members Toronto
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Performance & Quality/Auditor (Bilingual)
Only for registered members Toronto