Job TitleDental Claims AuditorLocationMississaugaEmployment TypePermanentWork ArrangementHybrid – 2 days a week on-siteDepartmentFraud, Waste, and AbusePay$58,000 – $63,000 annually (salary)Job SummaryThe Dental Claims Auditor conducts audits across Canada to ensure providers comply with benefit plan design and regulations, identifies trends from claim reviews, and recommends improvements to risk criteria. The role requires analytical and investigative skills, strong communication, and the ability to operate independently while maintaining high data integrity.Key ResponsibilitiesPerform claim verifications, desk and/or on‑site audits for Dental, Vision, Mental Health and other health benefits.Communicate with providers to gather information for audits, educate on claim submission practices, and respond to queries regarding audit results.Assess provider documentation to ensure compliance with enrollment agreements, benefit plan design, and provincial regulations.Calculate adjustments required to correct claim transactions.Travel to conduct on‑site audits at providers’ locations and complete post‑audit activities.Compile and produce detailed, unbiased audit reports.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.Identify trends from claim reviews and provide recommendations for risk criteria changes or candidates for desk or on‑site audits.Recommend incremental and continuous ideas to prevent and manage risk, adding value for customers.Respond to internal and external customer questions professionally, promptly,



and accurately.Complete any other duties and responsibilities assigned.QualificationsGraduate of a post‑secondary educational program as a dental assistant or dental hygienist with a valid license.2–5 years of recent experience in a dental office environment, with working knowledge of dental software and fee codes.Valid driver’s license and ability to travel within Canada (20–30% of time).In‑depth knowledge of dental benefits, reimbursement, and dental regulations.Previous audit or investigation experience is an asset.Ability to manage confidential information.Effective time‑management and organizational skills.Strong critical‑thinking, problem‑solving, and mediation skills.Self‑driven and capable of working independently with minimal supervision.Strong interpersonal skills; team player and collaborator across departments.Flexible, resourceful, and embracing change.Ability to manage high‑priority tasks in a fast‑paced environment.Research and communication skills for effectively presenting 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 is an asset.Ability to obtain and maintain an Enhanced Reliability Clearance from the Federal Government if required.BenefitsCompetitive compensation, benefits and pension plan.Career development and advancement opportunities.Culture that celebrates innovation and collaboration.Flexible work options and wellness programs.EEO StatementExpress Scripts Canada is an equal‑opportunity employer that promotes a diverse, inclusive and accessible workplace. We are committed to creating a barrier‑free workplace and providing accommodation for people with disabilities.#J-18808-Ljbffr

📌 Dental Claims Auditor - Express Scripts Canada - C$58,000 - C$63,000 A Year (Winnipeg)
🏢 Express Scripts Canada
📍 Winnipeg