Pharmacy Audit Specialist

2 weeks ago


Mississauga, Ontario, Canada Cigna Health and Life Insurance Company Full time

Cigna Health and Life Insurance Company seeks a highly skilled Pharmacy Audit Specialist to join its Business Integrity team in Mississauga, ON. As a valued member of our team, you will play a crucial role in ensuring the integrity of health claims while maintaining a network of providers.

Job Type: Full-time

Salary: $85,000 - $110,000 per year

Job Description

The successful candidate will be responsible for conducting various types of audits across Canada to validate that providers are compliant with benefit plan design and professional practice regulations.

  • Perform claim verifications, desk and/or on-site audits to ensure accuracy and quality of claim reviews.
  • Communicate with providers to gather information for audits, educate on claim submission practices, and respond to queries regarding audit results.
  • 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 audit reports that are detailed and unbiased.
Requirements

To be successful in this role, you must possess:

  • 2-5 years recent retail pharmacy experience with working knowledge of pharmacy software.
  • A valid driver's license and ability to travel in Canada (range of 5-15% of time).
  • Graduate of an accredited pharmacy education program.
  • In-depth knowledge of pharmacy benefits, reimbursement, and pharmacy regulations.
  • Previous audit/investigation experience.
  • Flexible, resourceful, with a mindset that embraces change.
What We Offer

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.



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