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Data Analyst (health claim audit)

Job Information
Author pmnationtalk
Date June 21, 2019
Type Full Time
Company Express Scripts Canada
Location Mississauga, ON
Category Medical / Health
Client Express Scripts Canada
Contact Information
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Data Analyst (health claim audit)

This role is required to support the Business Integrity Team. The Audit Data Analyst will support the requirements specific to ESC’s Audit Program including, managing risk criteria, data mining, making recommendations to the business and reporting of emerging trends. In addition, this role will support the development of new processes including operational dashboards that will provide the oversight of service standards and other metrics that will assist the Audit team to deliver quality and timely services to the client.

ESSENTIAL FUNCTIONS:

  • Analyze and identifies business trends and anomalies in all data outputs (Pharmacy, Dental and EHC) and is responsible for summarizing findings and making recommendations to business stakeholders with focus on streamlining processes and automation.
  • Work collaboratively with business stakeholders and data analysts to review, modify and help develop audit queries, tools and reports.
  • Helps develop and maintain operational dashboards such as KPI’s for oversight on department’s performance.
  • Construct workflow charts and diagrams and related documentation to support new processes
  • Support ad hoc analysis requests as required from cross functional teams
  • Monitor project process by tracking activity and providing progress updates
  • Present and report on data insights to customers
  • Is a key participant in strategic thinking for the progression of the department (using available data) and is able to assist with implementing industry initiatives and changes.

QUALIFICATIONS:

  • Bachelors degree or equivalent work experience
  • 3+ years relevant work experience in reporting or analytics
  • Experience working in health claims and/or audit
  • Advanced skills in MS Excel skills (create, edit, and run Excel based macros, work with advanced formulas, and pivot tables), power point, access database, knowledge with data analytic querying tools such as ACL, and SQL
  • Knowledge of audit an asset, data mining/analytic capabilities, process mapping, process documentation, creation of operational dashboards to display metrics in a visually appealing way
  • Strong interpersonal skills, communication skills, negotiating skills, creative and innovative thinking

ABOUT EXPRESS SCRIPTS CANADA

Express Scripts Canada, a registered business name of ESI Canada, an Ontario partnership indirectly controlled by Express Scripts, Inc. (Nasdaq: ESRX), is one of Canada’s leading providers of health benefits management services. From its corporate headquarters in Mississauga, Ontario, just outside Toronto, Express Scripts Canada provides a full range of integrated pharmacy benefit management (PBM) services to insurers, third-party administrators, plan sponsors and the public sector, including health-claims adjudication and processing services, Home Delivery Pharmacy Services, benefit-design consultation, drug-utilization review, formulary management, and medical and drug-data analysis services, to better facilitate the best possible health outcomes at the lowest possible cost.

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

We offer a competitive salary, 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. Thank you for your interest in this position, however only qualified candidates will be contacted for an interview. No telephone calls please.

For more information about Express Scripts Canada, visit its Web site at www.express-scripts.ca.

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