Job Title

Medical Claims Review Senior Advisor, which is a Band 4 Senior Contributor Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. NOTE: This position includes travelling (25%) across Canada. This is a 12 months contract with a strong possibility of extension. Key Responsibilities: Review provider claims reports to identify abnormal or inconsistent claims submissions Perform on-site audits at the providers location in Canada Review & summarize findings from provider chart/clinical notes, radiographs, lab bills, etc. Review audit reports for quality, accuracy, and proper audit application Provide clinical opinion to support audit specialists Participate as required in peer reviews with external clients Consult with internal and external stakeholders regarding audit activities Continuously review and provide recommendations regarding claims verification risk criteria Qualifications: Minimum of 5 years of recent and demonstrated experience within a dental office environment Current registration with a provincial college Ability to manage confidential information Strong focus on quality and accuracy Detail-oriented with proven high-level oral and written communication skills Demonstrates and applies integrity in all aspects of work Excellent time management and organizational skills Knowledge of Microsoft Office software (Word, Excel and PowerPoint) Bilingualism (French & English) is required. Express Scripts Canada has an exciting opportunity for a dentist who is looking to expand their career to use their analytical and investigative skills along with their practice and knowledge of benefit coverage. This part-time role in the Business Integrity team enhances 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. Responsabilits principales Rviser les rapports sur les demandes de rglement afin de dceler les demandes de rglement qui prsentent des anomalies ou des incohrences. Effectuer des audits sur place, dans des cabinets dentaires au Canada. Examiner les notes consignes aux dossiers des patients, les radiographies, les factures de laboratoire et rsumer ses constatations. Examiner les rapports daudit afin den assurer la qualit et lexactitude et de confirmer que le processus daudit a bien t suivi. Donner une opinion professionnelle afin dapporter du soutien aux spcialistes des audits. Participer des rvisions par les pairs, au besoin, avec les clients lexterne. Discuter des activits daudit avec les intervenants linterne et lexterne. Rviser les critres de risque relatifs la vrification des demandes de rglement et faire des recommandations. Qualification Possder cinq annes dexprience rcente dans un cabinet dentaire. tre membre dune association dentaire provinciale. tre en mesure de grer des renseignements confidentiels. Mettre laccent sur la qualit et lexactitude. tre minutieux et possder dexcellentes habilets de communication loral comme lcrit. Faire preuve dintgrit dans tous les aspects de son travail. Possder dexcellentes aptitudes en gestion du temps et avoir un bon sens de lorganisation. Connatre les logiciels de la suite Microsoft Office (Word, Excel et PowerPoint) tre bilingue (franais et anglais), loral comme lcrit. Note: Internal posting will be closed on October 13, 2025 Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. #J-18808-Ljbffr