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 objective of the Fraud Waste and Abuse program is to proactively detect and address risks in a timely manner that effectively manages the financial risk and reputation of Express Scripts Canada customers. As part of this team, the Operations Lead Analyst is responsible for administering operational efficiency processes that manage cost and optimize results, including financial data analysis and reporting. The Operations Lead Analyst presents opportunities and findings both verbally and in writing to key internal and external stakeholders, including coordinating and providing updates to private and public sector customers and other team(s) as necessary. The successful candidate will be involved in multiple projects and collaborate with department supervisors, managers and colleagues both in audit and in other ESC departments. This is an exciting opportunity for an adaptable candidate to gain experience and exposure to the administrative, financial and reporting operations of the audit department.
Key Responsibilities:
Produce financial reports for clients and provide insights into trends
Responsible for provider electronic withhold entries for audit recoveries for all benefits
Monitor electronic withhold to satisfy timely audit recoveries
Conduct quality review of audit reports for administrative accuracy and adherence to policies and timely submission to clients
Review claim selections to ensure adherence to program guidelines.
Collect and analyze quality assurance data for public sector client meetings and internal metrics
Lead audit report review meetings with clients and prepare meeting minutes
Ensure alignment and consistency of delivery of program between all benefits
Identify emerging trends and create presentations for clients to support audit result meetings
Work with both internal and external stakeholders to address client inquiries, gather, collect information, for deliverables
Conduct monthly quality assurance review of staff time trackers
Create and maintain forecasting tools for oversight on key performance indicators and emerging trends
Oversee program training documents, SOPs, and working instructions. Ensure processes are mapped out, outlined and organized for team to utilize
Maintain inventory of audit application scenarios to be used as a reference for team
Lead quality-focused remedial training sessions for team. Assist managers with maintaining training records
Identify, lead and manage special projects and program initiatives
Continuously seek opportunities to create efficiencies within processes and drive value for the program
Resolve non-routine issues escalated from other team members. Mentoring and developing team members using agile concepts.
Tasks involve a degree of forward planning and anticipation of needs/issues
Other duties as assigned
Qualifications:
Bachelor’s degree or equivalent work experience
Minimum of 4 years of related experience in Pharmacy and/or Dental Benefit Management, Group Insurance or Health Care Operations
Highly proficient in Microsoft Access & Excel, and data warehousing applications
Experience with compiling, manipulating or validating large pieces of data
Ability to maintain electronic filing systems
Display high levels of curiosity, integrity, tact and objective judgement
Excellent organizational, planning and critical thinking skills
Excellent verbal and written communication skills, including ability to present to clients and internal stakeholders
Proven interpersonal skills and ability to work well with senior management and high-level external contacts handling sensitive or confidential information is critical
Ability to work with minimum management oversight on multiple projects with competing priorities
Ability to work a flexible schedule in high pressure environments with urgent deadlines
Proven time and resource management skills; detail oriented with strong organizational abilities.
*Internal application deadline: January 26, 2025*
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
