Healthcare Compliance Specialist

3 weeks ago


Mississauga, Ontario, Canada The Cigna Group Full time

Job Summary

The Healthcare Compliance Specialist will play a key role in ensuring the integrity of health claims while maintaining a network of providers.

Key Responsibilities:

  • Conduct various types of audits across Canada to validate that providers are compliant with benefit plan design and professional practice regulations.
  • Use analytical and investigative skills along with knowledge of provincial benefit coverage to identify trends observed from claim reviews.
  • Communicate with providers to gather information for audits and to educate on claim submission practices.
  • Assess provider documentation to ensure compliance with ESC's provider agreement, benefit plan design, and provincial legislation.
  • Prepare audit reports that are detailed and unbiased.
  • Track audit activity and summarize results of claim analysis and recoveries.


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