Client Benefit Analyst
3 months ago
**Client Benefit Analyst - Non-Insured Health Benefit Program (NIHB)**
Express Scripts Canada administers on behalf of Indigenous Services Canada (the Client) Claim Adjudication. This role entails adjudicating Non-Insured Health Benefit Claims for Indigenous people in Canada.
As part of the Client Services team, the Client Benefit Analyst supports the Client as well as the Account Management team by acting as a key point of contact for client enquiries and issues. The Client Benefit Analyst triages and responds to all requests by delivering exceptional service, and striving to meet the service level agreements (SLA). The successful incumbent will ensure that complex client’ needs are, reviewed, addressed and resolved in a timely manner working in partnership with the Account Manager and internal partners. The team delivers consistently great customer service by providing support on various database, IT and adjudication inquiries, and coordinating with other departments to ensure the Client is fully supported.
**Key Responsibilities**:
- Triage requests and support and resolve client issues, critical inquiries and complaints with urgency and immediate action working in partnership with the Account Manager.
- Act as the adjudication system expert and provide technical expertise on Pharmacy/MS&E, Dental, Mental Health and Vision Systems and meet expected SLA’s (Service level agreement) and SDS’s (Service delivery standard).
- Act as the liaison between the Client and other Express Scripts Canada departments which include; Drug Plan Management, Provider Relations, Information Systems, Claims Processing and the Call Centre.
- Work closely alongside internal partners to identify and resolve client inquiries and escalate where needed.
- Conduct system change request testing internally and externally with the Client to ensure that all server releases are tested and approved by the Client.
- Where required, provide training to internal stakeholders on the Pharmacy/ MS&E, Dental, Mental Health and Vision benefits adjudication.
- Communicate to the Account Manager/Supervisor any escalations, issues, or concerns that might impact the relationship with the Client.
- Facilitate and attend various meetings with the Client and internal partners.
- Handle different client communications.
- Attend and facilitate the operational meetings and provide minutes for review approval to all stakeholders.
- Other duties as assigned.
**Qualifications**
- College Diploma or equivalent experience
- Bilingual (French and English, verbal and written) is considered an asset
- 3+ years’ experience in the field of Group Insurance, Pharmacy, Dental or Health Benefits Plans
- Pharmacy assistant/technician background and/or knowledge of government drug programs (Ontario Drug Benefits, Provincial Formularies, RAMQ) is an asset
- Excellent customer service capabilities
- Strong critical thinking, problem-solving and analytical skills
- Self-driven and, capable of working independently with mínimal supervision
- Strong interpersonal skills: team player and ability to work cross-functionally
- Able to work effectively with both internal/external customers
- Flexible, resourceful, with a mindset that embraces and champions change
- Shows initiative and passion about development and continuous learning
- Ability to multitask and prioritize based on urgency
- Excellent verbal and written communication skills
**Express Scripts Canada is a Cigna company**
Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. 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.
**About Express Scripts Canada**
Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada's leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. 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.
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.
We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing dive
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