Fraud, Waste and Abuse Dental Audit Manager - Express Scripts Canada
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- Mississauga, ON
- $80,000-100,000 per year
- Permanent
- Full-time
Employment Type: Full-timeReason for Vacancy: ReplacementWork Arrangement: Hybrid
Department Name: Fraud, Waste and AbusePay Type: SalariedPay Range: $80,000 to $100,000 Annually.Please note that this is a general posting range and offer range will be varied based on relevant experience, qualifications, skills required and location for this role.About UsExpress Scripts Canada (ESC) is a leading health benefits management company. Serving over 12 million members, we help insurance carriers, third party administrators, and the public sector optimize the value of health benefits by linking the talent and professional expertise of our people with leading edge information management systems and technology. ESC is a wholly owned subsidiary of Express Scripts Inc., one of the largest pharmacy benefit management (PBM) companies in North America, part of The Cigna Group (NYSE: CI), a global health company. Together, we deliver innovative, cost-effective solutions that improve access, affordability, and health outcomes for Canadians.Job Summary:Reporting to the Senior Manager of Clinical Services, Health Claims Administration and Fraud Waste and Abuse (FWA), the successful candidate will be responsible for managing the oversight and execution of our Dental FWA Program to ensure that client commitments and required service standards are delivered with timeliness and accuracy. The Dental FWA Manager will be required to meet regularly with customers to discuss the status of program results as well as identify opportunities to evolve the program, drive more value to customers and improve on service delivery. The successful incumbent will also provide direction and coaching to team members while overseeing the development and training of the department. In addition, the Dental FWA Manager will collaborate and work closely with the other managers withing the FWA department to co-lead and support the FWA Program.The Fraud, Waste and Abuse Management team’s mandate is to drive business value for customers by leading the industry in developing and using highly innovative and effective audit techniques to detect and address risk, ensuring the integrity of health and dental claims while maintaining a superior network of providers through diligent review and education.Key areas of leadership include – Teamwork, Operational Excellence, Performance Management, Customer Service, Innovation.This role directly contributes to building a high-performance culture within the team and the organization.Key ResponsibilitiesLead the Dental FWA team and oversee the development and ongoing maintenance of the Dental FWA operational policies, standards and procedures, in keeping with provincial regulations and practices, client requirements and provider agreements and manuals.Provide direction, coaching and training of department to ensure high quality service that will meet both internal and external needsActively build and manage relationships with business partners and communicate effectively with internal colleagues, dental professionals, legal teams, regulatory associations and law enforcement authoritiesEnsure the standardization of practice throughout the Dental FWA team and ensures that systems, procedures and personnel are available to efficiently provide FWA services to meet our customer service level agreements and department objectivesSupport the design and building phase of high complexity business applications and oversees the implementation to ensure quality systems produce and maintain the desired resultsEvaluate products against business specifications to determine the optimum solution for the organization and our client baseResponsible for ensuring client commitments are met, to present audit findings and recommendations to internal and external customers, and to ensure proper workflow and process managementSchedule and track all day-to-day audit activities/services of the team and monitors audit findings to ensure effective resolutionActively manage the team to ensure effective resource allocation and consistent financial performance against budgetsOversees the production of departmental reports as required by the senior leadership team and subsequent distribution to relevant personnel and clientsDevelops the annual audit plan and department budget and oversees the billing of Task Authorizations to ensure accurate capture and forecasting of revenuesIdentifies key initiatives to improve processes, quality and efficienciesEducates others in the organization about claims practices and the ability to identify opportunities for improvement and provides leadership in development of new ideasWhat We’re Looking For:Diploma in a relevant field from an accredited institution5+ years of experience in dental office settingsKnowledge of provincial and federal regulations and legislationExperience in group benefits, including dental; clinical background and dental software familiarity an assetGovernance, regulatory, and audit experience; accreditation in audit an assetProven managerial ability with strong people management and talent development skillsDemonstrated change management, cross-functional collaboration, and interpersonal effectivenessStrong prioritization and time/resource management, with the ability to thrive in fast-paced environmentsStrong focus on quality, accuracy, customer service, and professional presentationExcellent oral and written communication skills; bilingualism (French/English) a strong assetProficient in Microsoft Office (Word, Excel, PowerPoint)Why Join Us?Competitive compensation, benefits and pension planCareer development and advancement opportunitiesA culture that celebrates innovation and collaborationFlexible work options and wellness programsPre-Employment RequirementsAll offers of employment are conditional upon the successful completion of reference checks and background verification in accordance with company policy. Within ESC, for certain positions, obtaining and maintaining a federal government security clearance is a condition of employment. Candidates applying for such roles must meet all eligibility criteria for the applicable clearance level and consent to the security screening process as mandated by federal regulations. Failure to obtain or maintain the required clearance will result in withdrawal of the offer or termination of employment.Our hiring process includes AI-powered tools to conduct video interviews, take notes and score candidates; however, all scores will be reviewed by hiring managers and our Talent team before making a decision.NOTE: Internal candidates should apply before April 15, 2026.Express Scripts Canada is a Cigna companyExpress Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.About Express Scripts CanadaExpress Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada's leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy™ services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.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.We are 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.If you require accommodation in completing the online application process, please email: Do not email for an update on your application or to provide your resume as you will not receive a response.