Job Description

Position Type:
Permanent

If you're looking for a fulfilling career that can make a real difference in your life, and the lives of others, you've come to the right place.

As a national health solutions partner, we put people first in everything we do - and that begins with our team of 8,000+ professionals who bring a cross-section of diverse life experiences and career expertise to Medavie. By collaborating and innovating together, our employees are creating industry-leading solutions in insurance, primary care and emergency medical services that impact millions of lives in Canada each year.

Our mission is to improve the wellbeing of Canadians so that every life can be lived to the fullest - and it's reflected in our award-winning culture. We celebrate individuality and value the diverse perspectives and skills our employees contribute. We go beyond providing competitive pay and comprehensive benefits to offer opportunities for personal and professional growth, flexible work options, meaningful experiences, and supportive leadership. Medavie is where employees can be their best selves, feel they belong, and achieve their full potential. Be part of it by applying for a position with us today.

The Opportunity

We are seeking a driven, detail-oriented professional to join our dynamic Provider Audit team as an Audit Investigator - Pharmacy . In this critical role, you will leverage advanced audit and analytical tools to identify abnormal claiming patterns within our pharmacy provider network for the company's drug benefit programs. Your keen investigative skills will be essential in safeguarding the integrity of our programs. You'll also be expected to build strong, proactive relationships with both service providers and customers, ensuring clear, efficient communication while addressing concerns and providing insights. This is an exciting opportunity to make a meaningful impact while working in an energetic and engaging environment.

Responsibilities

• Performing audits of pharmacy providers including: pre-audit and post-audit work; determining the most appropriate course of action based on your findings; compiling findings; and completing final case reports.
• Planning, performing, and leading claims audits and other investigative engagements.
• Applying query analytics and expert software to profile for indicators of inappropriate claims submissions by pharmacy providers.
• Summarizing findings, recommendations, and corrective actions in written reports.
• Building, developing and maintaining strong relationships with colleagues and customers, to encourage open dialogue and collaborative commitment to problem solving, continuous improvement, and corporate risk mitigation.
• Maintaining a commitment to ongoing learning, developing audit skills in line with best-practice, and building a strong foundation in insurance and healthcare industry principles and knowledge.
• Leading and assisting in the performance of other unique risk-based projects.

Requirements

• Professional designation as a Pharmacy Technician/ Assistant or professional experience in the pharmaceutical field.
• Demonstrated computer skills (including word processing, spreadsheets, flowcharts, etc.).
• Excellent initiative, problem solving, and analytical skills.
• Ability to articulate thoughts in a clear and concise manner (both verbal and written).
• Ability to manage multiple competing priorities and tight deadlines.
• Ability to travel across Canada 3-4 weeks per year (non-consecutive).
• Valid Driver's license.

Assets

• Knowledge of audit principles, practices and methodologies acquired preferably through 1-3+ years of experience in auditing and/or investigative practices.
• Use of data analytics software (e.g. ACL, Excel, etc.), along with an ability to learn and apply statistical inference and data sampling principles to large data populations would be idea.
• Professional designation in fraud detection, auditing or investigative techniques (e.g. CPA, CA, CMA, CGA, CIA, CFE, etc.).

#CBM1

#LI-VS1

We believe our employees should reflect the communities we serve and welcome applications from candidates of all backgrounds. To provide the best experience possible, we will support you with accommodations or adjustments at any stage of the recruitment process. Simply inform our Recruitment team of your needs. We are committed to making sure recruitment, retention, advancement, and compensation are fair and accessible while following all relevant human rights and privacy laws . We appreciate everyone who has shown interest in this position. Only those selected for an interview will be contacted.

If you experience any technical issues throughout the application process, please email: [email protected] .

Job Tags

Similar Jobs