Manager, Health Claims and Administration

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Manager, Health Claims and Administration

Job Information
Author pmnationtalk
Date October 17, 2020
Type Full Time
Company Express Scripts Canada
Location Toronto, ON
Category Medical / Health
Client Express Scripts Canada
Contact Information
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Manager, Health Claims and Administration – Express Scripts Canada

Reporting to the Senior Manager, Health Claims Services, the Manager of Health Claims and Administration will be the role responsible for claims processing services for both lines of business, NIHB and Book of Business accounts.  This position has responsibility for ensuring that contractual service levels and budgets are met and mitigation of risks for security, privacy and financial errors. This position directly oversees three team leads.

Key Responsibilities:

  • Ensure all contractual customer service and quality targets are achieved to avoid penalty payments.
  • Implement and monitor departmental metrics to ensure service standards are met
  • Monitor operational processes and identify process improvements, efficiencies and automation to optimize results
  • Manage staff performance through coaching and mentoring and ensure skill development and cross training to create bench strength
  • Provide daily guidance on security, privacy and financial risk mitigation in order to optimize results and create a high performance work environment
  • Provide weekly operational updates to senior management regarding service levels.  Attend client operational meetings and represent operations in customer audits and business continuity exercises
  • Manage FTE, budget and forecasting targets
  • Manage oversight of team for end to end workflows including distribution of claims
  • Manage team performance ensuring adherence to quality and productivity standards
  • Answer system questions and resolve NIHB issues and escalations. Provide support to internal partners ensuring timely and accurate response to customer needs
  • Facilitates Quality Assurance process with NIHB and act as QA Coordinator with respect to system and non-system deliverables making sure consistent quality of service is met in system/operational/documentation issues
  • Facilitate and coordinate all Operational meetings with NIHB and ensure that the applicable departments answered/investigated all operational issues
  • Conduct system change request testing internally and externally with our clients to ensure that all server releases are tested and signed off on
  • Responsible for handling of high level/critical day-to-day inquiries ensure the appropriate departments take immediate action
  • Work with internal support teams to identify and resolve customer needs through escalation process. Handle technical issues while escalating business or strategic issues to Account Manager


  • BA/BS or relevant working experience
  • Experience in group insurance / operations
  • 5 years people leadership experience
  • FLMI or other group insurance industry courses
  • Proficient in MS office applications
  • Ability to manage operational processes and budgets totaling approximately 3 million; Ability to coach, develop talent and motivate teams to meet objectives.  Strong analytical, critical thinking and problem solving skills. Strong communication and presentation skills.  Will be required to have direct contact with both internal and external customers.  Ability to build strong teams and create a high performance culture. Up to 10% travel.

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: [email protected] Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.

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