Fraud, Waste and Abuse Dental Audit Manager Express Scripts Canada

Job Title: Fraud Waste and Abuse Dental Audit Manager

Location: Mississauga ON
Employment Type: Full-time

Reason for Vacancy: Replacement

Work Arrangement: Hybrid
Department Name: Fraud Waste and Abuse

Pay Type: Salaried

Pay Range: $80000 to $100000 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:

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 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 teams 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 Responsibilities

• Lead 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 needs

• Actively build and manage relationships with business partners and communicate effectively with internal colleagues dental professionals legal teams regulatory associations and law enforcement authorities

• Ensure 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 objectives

• Support the design and building phase of high complexity business applications and oversees the implementation to ensure quality systems produce and maintain the desired results

• Evaluate products against business specifications to determine the optimum solution for the organization and our client base

• Responsible for ensuring client commitments are met to present audit findings and recommendations to internal and external customers and to ensure proper workflow and process management

• Schedule and track all day-to-day audit activities/services of the team and monitors audit findings to ensure effective resolution

• Actively manage the team to ensure effective resource allocation and consistent financial performance against budgets

• Oversees the production of departmental reports as required by the senior leadership team and subsequent distribution to relevant personnel and clients

• Develops the annual audit plan and department budget and oversees the billing of Task Authorizations to ensure accurate capture and forecasting of revenues

• Identifies key initiatives to improve processes quality and efficiencies

• Educates others in the organization about claims practices and the ability to identify opportunities for improvement and provides leadership in development of new ideas

What Were Looking For:

• Diploma in a relevant field from an accredited institution

• 5 years of experience in dental office settings

• Knowledge of provincial and federal regulations and legislation

• Experience in group benefits including dental; clinical background and dental software familiarity an asset

• Governance regulatory and audit experience; accreditation in audit an asset

• Proven managerial ability with strong people management and talent development skills

• Demonstrated change management cross-functional collaboration and interpersonal effectiveness

• Strong prioritization and time/resource management with the ability to thrive in fast-paced environments

• Strong focus on quality accuracy customer service and professional presentation

• Excellent oral and written communication skills; bilingualism (French/English) a strong asset

• Proficient in Microsoft Office (Word Excel PowerPoint)

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 April 15 2026.