Fraud, Waste, and Abuse Program Manager – Extended Health Care (Pharmacy included)

The Fraud, Waste and Abuse (FWA) team mandate is to drive business value for clients by developing and using highly innovative and effective audit and investigation techniques to detect and address risk, ensuring the integrity of health, dental and extended healthcare (EHC) claims while maintaining a superior network of providers through diligent review, education and adherence protocols.

Reporting to the Senior Manager – FWA and HCA, the EHC and FWA Program Manager will be responsible for managing the relationships with ESC clients and delivering FWA services of the highest quality. This includes contributing to FWA team objectives to meet and exceed client value expectations and be recognized as knowledge experts in healthcare FWA. This position will lead a team comprised of various roles to support program development, alignment across various FWA teams, govern change management and support delivery of superior quality FWA services to ESC clients. This role is also required to drive and participate in strategic planning activities for the FWA program as well as supporting new business activities by actively participating in sales presentations and assisting with responses to quotes. This job should directly contribute to building a high-performance culture and living the Cigna values.

ESSENTIAL FUNCTIONS: 

• Responsible for the development and ongoing maintenance of the FWA Program standards and procedures, in keeping with provincial provider regulations and practices.
• Support communication protocols with providers and clients to achieve response and resolution of FWA related issues.
• Organizing and representing ESC at private and public sector customer meetings related to FWA.
• Takes a lead role in the design and building phase of high complexity business applications to ensure quality systems produce the desired results.
• Support the evaluation of products against business specifications to determine optimum solution for the organization.
• Facilitate change management and implementation by leading local projects that fall within the larger scope of the business and strategic planning.
• Accountability for managing resources that support reporting, budgeting and forecasting processes
• Represent ESC on committees/associations such as CHLIA as required
• Responsible for managing the execution of FWA extended healthcare service delivery within service standards
• Lead and engage the FWA Audit Program team in achieving corporate and department strategic goals/objectives and develop initiatives aligned with these objectives to maximize best outcomes
• Foster a people first culture that develops the skills and capabilities of team members to enable personal and business growth
• Ensure that team members are effectively trained and are provided with the appropriate tools, including evergreen process documentation, to reach success in their roles
• Work cross functionally with ESC teams to enable best holistic outcomes for the organization
• Support the identification and review of challenging areas within the FWA team and provide recommendations to leaders to ensure consistent delivery of their services with quality and on time

QUALIFICATIONS 

• University degree or equivalent
• Valid license to practice pharmacy in Canada
• Minimum 5 years of experience practicing as a pharmacist
• Strong leadership and management skills
• Experience in healthcare insurance and/or benefit industry including provider practice regulations and familiarity with provider software systems
• Ability to work effectively with internal and external clients
• Excellent time and resource management skills.
• Proven ability to manage multiple high priority tasks in a fast-paced and evolving organization.
• Excellent interpersonal skills to facilitate change management.
• Experience identifying trends and process gaps, analyzing information, recommending, developing and implementing creative and effective solutions and providing strategic input.
• Must be team and detail oriented.
• Excellent critical thinking and analytical skills and verbal and written communication skills
• Self-starter able to work in a dynamic environment and make independent decisions
• Proven experience in applying agile principles and practices when executing on deliverables
• Knowledge of computer applications (Word, Excel, PowerPoint)
• Internal application deadline: February 1 by 11:59pm*

Express Scripts Canada is a Cigna company

Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

About Express Scripts Canada

Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada’s leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy™ services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.

It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.

We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.

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: eschr2@express-scripts.com Do not email eschr2@express-scripts.com for an update on your application or to provide your resume as you will not receive a response.

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The Fraud, Waste and Abuse (FWA) team mandate is to drive business value for clients by developing and using highly innovative and effective audit and investigation techniques to detect and address risk, ensuring the integrity of health, dental and extended healthcare (EHC) claims while maintaining a superior network of providers through diligent review, education and adherence protocols.

Reporting to the Senior Manager – FWA and HCA, the EHC and FWA Program Manager will be responsible for managing the relationships with ESC clients and delivering FWA services of the highest quality. This includes contributing to FWA team objectives to meet and exceed client value expectations and be recognized as knowledge experts in healthcare FWA. This position will lead a team comprised of various roles to support program development, alignment across various FWA teams, govern change management and support delivery of superior quality FWA services to ESC clients. This role is also required to drive and participate in strategic planning activities for the FWA program as well as supporting new business activities by actively participating in sales presentations and assisting with responses to quotes. This job should directly contribute to building a high-performance culture and living the Cigna values.

ESSENTIAL FUNCTIONS: 

• Responsible for the development and ongoing maintenance of the FWA Program standards and procedures, in keeping with provincial provider regulations and practices.
• Support communication protocols with providers and clients to achieve response and resolution of FWA related issues.
• Organizing and representing ESC at private and public sector customer meetings related to FWA.
• Takes a lead role in the design and building phase of high complexity business applications to ensure quality systems produce the desired results.
• Support the evaluation of products against business specifications to determine optimum solution for the organization.
• Facilitate change management and implementation by leading local projects that fall within the larger scope of the business and strategic planning.
• Accountability for managing resources that support reporting, budgeting and forecasting processes
• Represent ESC on committees/associations such as CHLIA as required
• Responsible for managing the execution of FWA extended healthcare service delivery within service standards
• Lead and engage the FWA Audit Program team in achieving corporate and department strategic goals/objectives and develop initiatives aligned with these objectives to maximize best outcomes
• Foster a people first culture that develops the skills and capabilities of team members to enable personal and business growth
• Ensure that team members are effectively trained and are provided with the appropriate tools, including evergreen process documentation, to reach success in their roles
• Work cross functionally with ESC teams to enable best holistic outcomes for the organization
• Support the identification and review of challenging areas within the FWA team and provide recommendations to leaders to ensure consistent delivery of their services with quality and on time

QUALIFICATIONS 

• University degree or equivalent
• Valid license to practice pharmacy in Canada
• Minimum 5 years of experience practicing as a pharmacist
• Strong leadership and management skills
• Experience in healthcare insurance and/or benefit industry including provider practice regulations and familiarity with provider software systems
• Ability to work effectively with internal and external clients
• Excellent time and resource management skills.
• Proven ability to manage multiple high priority tasks in a fast-paced and evolving organization.
• Excellent interpersonal skills to facilitate change management.
• Experience identifying trends and process gaps, analyzing information, recommending, developing and implementing creative and effective solutions and providing strategic input.
• Must be team and detail oriented.
• Excellent critical thinking and analytical skills and verbal and written communication skills
• Self-starter able to work in a dynamic environment and make independent decisions
• Proven experience in applying agile principles and practices when executing on deliverables
• Knowledge of computer applications (Word, Excel, PowerPoint)
• Internal application deadline: February 1 by 11:59pm*

Express Scripts Canada is a Cigna company

Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

About Express Scripts Canada

Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada’s leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy™ services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.

It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.

We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.

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: eschr2@express-scripts.com Do not email eschr2@express-scripts.com for an update on your application or to provide your resume as you will not receive a response.

Read Full Description