Job Title: Dental Claims Auditor

Location: Mississauga

Employment Type: Contract 12-Months

Work Arrangement: Hybrid, 2 days a week on-site

Department: Fraud, Waste, and Abuse

Pay: $32–$35.00 per hour (general posting range, actual offer based on experience)

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 for conducting various types of audits across Canada to validate that providers are compliant with benefit plan design and skilled 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 regarding 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 conduct on-site audit at the provider’s 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 departmental 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

Qualifications & Experience

- 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 driver’s 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

Benefits

- 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. Candidates for certain positions must meet all eligibility criteria for the applicable federal security 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.

EEO & Accommodation Statement

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:

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📌 Dental Claims Auditor - 12 Month Contract - Express Scripts Canada (Mississauga)
🏢 Express Scripts Pharmacy Benefit Services
📍 Mississauga