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Job Title: Fraud, Waste and Abuse Dental Audit ManagerLocation: Mississauga, ON

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Employment Type: Full-timeReason for Vacancy: ReplacementWork Arrangement: Hybrid

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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 cutting-edge, 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, includin

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📌 Fraud, Waste and Abuse Dental Audit Manager - Express Scripts Canada (Mississauga)
🏢 The Cigna Group
📍 Mississauga