Description
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
The Fraud, Waste and Abuse (FWA) team mandate is to drive business value for clients by developing and using highly innovative and effective audit and investigation techniques to detect and address risk, ensuring the integrity of health, dental and extended healthcare (EHC) claims while maintaining a superior network of providers through diligent review, education and adherence protocols.
Reporting to the Senior Manager - FWA and HCA, the EHC and FWA Program Manager will be responsible for managing the relationships with ESC clients and delivering FWA services of the highest quality. This includes contributing to FWA team objectives to meet and exceed client value expectations and be recognized as knowledge experts in healthcare FWA. This position will lead a team comprised of various roles to support program development, alignment across various FWA teams, govern change management and support delivery of superior quality FWA services to ESC clients. This role is also required to drive and participate in strategic planning activities for the FWA program as well as supporting new business activities by actively participating in sales presentations and assisting with responses to quotes. This job should directly contribute to building a high-performance culture and living the Cigna values.
ESSENTIAL FUNCTIONS:
Responsible for the development and ongoing maintenance of the FWA Program standards and procedures, in keeping with provincial provider regulations and practices.
Support communication protocols with providers and clients to achieve response and resolution of FWA related issues.
Organizing and representing ESC at private and public sector customer meetings related to FWA.
Takes a lead role in the design and building phase of high complexity business applications to ensure quality systems produce the desired results.
Support the evaluation of products against business specifications to determine optimum solution for the organization.
Facilitate change management and implementation by leading local projects that fall within the larger scope of the business and strategic planning.
Accountability for managing resources that support reporting, budgeting and forecasting processes
Represent ESC on committees/associations such as CHLIA as required
Responsible for managing the execution of FWA extended healthcare service delivery within service standards
Lead and engage the FWA Audit Program team in achieving corporate and department strategic goals/objectives and develop initiatives aligned with these objectives to maximize best outcomes
Foster a people first culture that develops the skills and capabilities of team members to enable personal and business growth
Ensure that team members are effectively trained and are provided with the appropriate tools, including evergreen process documentation, to reach success in their roles
Work cross functionally with ESC teams to enable best holistic outcomes for the organization
Support the identification and review of challenging areas within the FWA team and provide recommendations to leaders to ensure consistent delivery of their services with quality and on time
QUALIFICATIONS
University degree or equivalent
Valid license to practice pharmacy in Canada
Minimum 5 years of experience practicing as a pharmacist
Strong leadership and management skills
Experience in healthcare insurance and/or benefit industry including provider practice regulations and familiarity with provider software systems
Ability to work effectively with internal and external clients
Excellent time and resource management skills.
Proven ability to manage multiple high priority tasks in a fast-paced and evolving organization.
Excellent interpersonal skills to facilitate change management.
Experience identifying trends and process gaps, analyzing information, recommending, developing and implementing creative and effective solutions and providing strategic input.
Must be team and detail oriented.
Excellent critical thinking and analytical skills and verbal and written communication skills
Self-starter able to work in a dynamic environment and make independent decisions
Proven experience in applying agile principles and practices when executing on deliverables
Knowledge of computer applications (Word, Excel, PowerPoint)
*Internal application deadline: February 1 by 11:59pm*
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
