Job Title: Fraud, Waste and Abuse Operations Lead Analyst

Location: 300 – 6985 Financial Drive Mississauga Ontario
Employment Type:  Contract 1 Year

Reason for Vacancy: Replacement

Work Arrangement: Hybrid
Department Name: Fraud, Waste and Abuse

Pay Type: Salaried

Pay Range: $60,000-$68,000. Please note that this is a general posting range and offer range will be varied based on relevant experience, qualifications, skills required and location for this role.

About Us

Express Scripts Canada (ESC) is a leading health benefits management company. Serving over 12 million members, we help insurance carriers, third party administrators, and the public sector optimize the value of health benefits by linking the talent and professional expertise of our people with leading edge information management systems and technology. ESC is a wholly owned subsidiary of Express Scripts Inc., one of the largest pharmacy benefit management (PBM) companies in North America, part of The Cigna Group (NYSE: CI), a global health company. Together, we deliver innovative, cost-effective solutions that improve access, affordability, and health outcomes for Canadians.

Job Summary:

The Operations Lead Analyst is responsible for administering operational efficiency processes that manage cost and optimize results, including financial data analysis and reporting as part of the Fraud, Waste and Abuse Program (FWA). 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 internal team(s) as necessary. The successful candidate will be involved in multiple projects and collaborate with department supervisors, managers and colleagues both in FWA and other cross functional departments. This is an exciting opportunity for an adaptable candidate to gain experience and exposure to the administrative, financial and reporting operations of the FWA 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 and monitor electronic withhold to satisfy timely audit recoveries
• Collect and analyze quality assurance data for public sector client meetings and internal metrics
• 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
• 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
• Tasks involve a degree of forward planning and anticipation of needs/issues
• Other duties as assigned

Qualifications

• Post secondary degree or equivalent work experience
• 3+ years of related experience in Pharmacy and/or Dental Benefits Management, Group Insurance or Health Care Operations
• Demonstrated experience in quality assurance activities, data analysis, and reporting
• 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

Why Join Us?

• Competitive compensation, benefits and pension plan
• Career development and advancement opportunities
• A culture that celebrates innovation and collaboration
• Flexible work options and wellness programs

Pre-Employment Requirements

All offers of employment are conditional upon the successful completion of reference checks and background verification in accordance with company policy. Within ESC, for certain positions, obtaining and maintaining a federal government security clearance is a condition of employment. Candidates applying for such roles must meet all eligibility criteria for the applicable clearance level and consent to the security screening process as mandated by federal regulations. Failure to obtain or maintain the required clearance will result in withdrawal of the offer or termination of employment.

Our hiring process includes AI-powered tools to conduct video interviews, take notes and score candidates; however, all scores will be reviewed by hiring managers and our Talent team before making a decision.