Dental Claims Auditor Express Scripts Canada

Job Title: Dental Claims Auditor

Location: Mississauga
Employment Type: Permanent

Reason for Vacancy: New Headcount

Work Arrangement: Hybrid 2 days a week on-site

Department Name: Fraud Waste and Abuse

Pay Type: Salary

Pay Range: $58000 $63000 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 Us

Express 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:

The role of the Fraud Waste & Abuse team is to enhance the Express Scripts Canada (ESC) value proposition for customers to ensure the integrity of health claims while maintaining a network of providers through diligent review and education. The Auditor is responsible to conduct various types of audits across Canada to validate that providers are compliant with benefit plan design and professional practice regulations. The Auditor uses their analytical and investigative skills along with their practice and knowledge of provincial benefit coverage to identify trends observed from claim reviews and to ensure that the audit techniques evolve to remain effective in managing risk for ESC customers.

Key Responsibilities

• Perform claim verifications desk and/or on-site audits for Dental Vision Mental Health and other healthcare benefits as needed

• Communicate with providers to gather information for audits to educate on claim submission practices and to respond to queries in regards to audit results

• Assess provider documentation to ensure compliance with enrolment agreement benefit plan design and provincial regulations.

• Calculate the adjustments required to correct claim transactions

• Prepare coordinate and travel to conducton-site audit at the providers location and complete the post on-site audit activities

• Compile and produce audit reports that are detailed and unbiased

• Perform self and peer-review to ensure accuracy and quality of claim reviews

• Track audit activity and summarize results of claim analysis and recoveries on a daily and/or monthly basis for department statistics for presentation to customers

• Identify trends observed from claim reviews and provide recommendations for risk criteria changes and/or candidates for a desk or on-site audit.

• Recommend incremental and continuous ideas that will increase ability to prevent and manage risk that will bring the most value to customers

• Respond to internal and external customer questions professionally timely and accurately

• Other duties and responsibilities as assigned

What Were Looking For:

• Graduate of post-secondary educational program either as a dental assistant or dental hygienist with a valid license

• 2-5 years recent experience in a dental office environment with working knowledge of dental software and fee codes

• Valid drivers license and ability to travel in Canada range of 20-30% of time

• In-depth knowledge of dental benefits reimbursement and dental regulations

• Previous audit/investigation experience is an asset

• Ability to manage confidential information

• Effective time management and organizational skills

• Strong critical thinking skills with ability to analyze problem-solve and mediate difficult situations

• Self-driven curious capable of working independently with minimal supervision

• Strong interpersonal skills: team player and ability to work cross-functionally with other departments

• Flexible resourceful with a mindset that embraces and champions change

• Ability to manage high priority tasks in a fast-paced environment

• Ability to research and effectively communicate findings

• Passionate about development and continuous learning

• Excellent verbal and written communication skills

• Proficiency in MS Office (Excel Word Outlook)

• Bilingualism (French & English) is an asset

• LOMA or HIAA training would be an asset

Why Join Us

• Competitive compensation benefits and pension plan

• Career development and advancement opportunities

• A culture that celebrates innovation and collaboration

• Flexible work options and wellness programs

Pre-Employment Requirements

All 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 May 29 2026.