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Pharmacy Claims Auditor
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Mississauga, Ontario, Canada Cigna Health and Life Insurance Company Full timePharmacy Claims Auditor Job DescriptionWe are seeking a highly skilled Pharmacy Claims Auditor to join our team at Cigna Health and Life Insurance Company. As a Pharmacy Claims Auditor, you will play a critical role in ensuring the integrity of health claims and maintaining a network of providers through diligent review and education.Key...
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Pharmacy Claims Auditor
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Mississauga, Ontario, Canada The Cigna Group Full timeJob Title: Pharmacy Claims AuditorThe Pharmacy Claims Auditor plays a critical role in ensuring the integrity of healthcare claims and maintaining a network of providers through diligent review and education. This position requires a strong analytical and investigative mindset, with the ability to analyze and problem-solve complex situations.Key...
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Pharmacy Claims Auditor
4 weeks ago
Mississauga, Ontario, Canada The Cigna Group Full timeJob Title: Pharmacy Claims AuditorThe Pharmacy Claims Auditor plays a critical role in ensuring the integrity of healthcare claims and maintaining a network of providers through diligent review and education. This position requires a strong analytical and investigative mindset, with the ability to analyze and problem-solve complex situations.Key...
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Pharmacy Claims Auditor
4 weeks ago
Mississauga, Ontario, Canada The Cigna Group Full timeJob Title: Pharmacy Claims AuditorThe Pharmacy Claims Auditor plays a critical role in ensuring the integrity of healthcare claims and maintaining a network of providers. This position requires a strong analytical and investigative mindset, with the ability to identify trends and ensure compliance with benefit plan design and professional practice...
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Pharmacy Claims Auditor
4 weeks ago
Mississauga, Ontario, Canada The Cigna Group Full timeJob Title: Pharmacy Claims AuditorThe Pharmacy Claims Auditor plays a critical role in ensuring the integrity of healthcare claims and maintaining a network of providers. This position requires a strong analytical and investigative mindset, with the ability to identify trends and ensure compliance with benefit plan design and professional practice...
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Pharmacy Claims Auditor
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Mississauga, Ontario, Canada The Cigna Group Full timeJob Title: Pharmacy Claims AuditorThe Pharmacy Claims Auditor plays a crucial role in ensuring the integrity of health claims and maintaining a network of providers through diligent review and education. This position requires strong analytical and investigative skills, as well as in-depth knowledge of pharmacy benefits, reimbursement, and pharmacy...
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Pharmacy Claims Auditor
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Mississauga, Ontario, Canada The Cigna Group Full timeJob Title: Pharmacy Claims AuditorThe Pharmacy Claims Auditor plays a critical role in ensuring the integrity of healthcare claims and maintaining a network of providers. This position requires a strong analytical and investigative mindset, with the ability to identify trends and ensure compliance with benefit plan design and professional practice...
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Pharmacy Claims Auditor
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Mississauga, Ontario, Canada The Cigna Group Full timeJob Title: Pharmacy Claims AuditorThe Pharmacy Claims Auditor plays a critical role in ensuring the integrity of healthcare claims and maintaining a network of providers. This position requires a strong analytical and investigative mindset, with the ability to identify trends and ensure compliance with benefit plan design and professional practice...
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Pharmacy Claims Auditor
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Mississauga, Ontario, Canada The Cigna Group Full timeThe Pharmacy Claims Auditor role at The Cigna Group is a critical position that requires a strong analytical mindset and attention to detail. As a key member of our Business Integrity team, you will be responsible for conducting audits across Canada to ensure the integrity of health claims and maintain a network of providers.Key Responsibilities:Perform...
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Pharmacy Claims Auditor
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Mississauga, Ontario, Canada The Cigna Group Full timeThe Pharmacy Claims Auditor role is a critical component of the Business Integrity team at The Cigna Group. As a key member of this team, you will be responsible for conducting audits across Canada to ensure that healthcare providers are compliant with benefit plan design and professional practice regulations. Your analytical and investigative skills will be...
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Pharmacy Claims Auditor
2 weeks ago
Mississauga, Ontario, Canada The Cigna Group Full timeAbout the Role:The Pharmacy Claims Auditor will play a critical role in ensuring the integrity of health claims and maintaining a network of providers through diligent review and education. This position requires strong analytical and investigative skills, as well as in-depth knowledge of pharmacy benefits, reimbursement, and regulations.Key...
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Pharmacy Claims Auditor
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Insurance Claims Auditor
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Pharmacy Claims Auditor
1 month ago
The Pharmacy Claims Auditor plays a critical role in ensuring the integrity of healthcare claims and maintaining a network of providers. This position involves conducting audits across Canada to validate that providers are compliant with benefit plan design and professional practice regulations.
Key Responsibilities:- Perform claim verifications, desk and/or on-site audits to ensure compliance with regulatory requirements.
- Communicate with providers to gather information for audits, educate on claim submission practices, and respond to queries regarding audit results.
- Assess provider documentation to ensure compliance with ESC's provider agreement, benefit plan design, and provincial legislation.
- Calculate adjustments required to correct claim transactions.
- Prepare, coordinate, and travel to conduct on-site audits at the provider's location, and complete post-audit activities.
- Compile and produce detailed and unbiased audit reports.
- Perform self and peer reviews 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.
- 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 the ability to prevent and manage risk that will bring the most value to customers.
- Respond to internal and external customer questions professionally, timely, and accurately.
- 2-5 years recent retail pharmacy experience with working knowledge of pharmacy software.
- Valid driver's license and ability to travel in Canada, range of 5-15% of time.
- Graduate of an accredited pharmacy education program; R Ph.T. designation is preferred.
- In-depth knowledge of pharmacy benefits, reimbursement, and pharmacy regulations.
- Previous audit/investigation experience.
- Ability to manage confidential information.
- Effective time management and organizational skills.
- Strong critical thinking skills with the ability to analyze, problem-solve, and mediate difficult situations.
- Self-driven, curious, and capable of working independently with minimal supervision.
- Strong interpersonal skills: team player and ability to work cross-functionally with other departments.
- Flexible, resourceful, with a mindset that embraces and champions change.
- Ability to manage high-priority tasks in a fast-paced environment.
- Ability to research and effectively communicate findings.
- Passionate about development and continuous learning.
- Excellent verbal and written communication skills.
- Proficiency in MS Office (Excel, Word, Outlook).
- Bilingualism (French & English) is an asset.
- LOMA or HIAA training would be an asset.
Cigna is an equal opportunity employer that promotes a diverse, inclusive, and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.
We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.
