Operations Lead Analyst, Fraud, Waste and Abuse - 12 Month Contract - Express Scripts Canada

Cigna Healthcare•Mississauga, ON

36d•CA$32 - CA$37•Hybrid

About The Position

The Operations Lead Analyst is responsible for administering operational efficiency processes that manage cost and optimize results, including financial data analysis and reporting as part of the Fraud, Waste and Abuse Program (FWA). The Operations Lead Analyst presents opportunities and findings both verbally and in writing to key internal and external stakeholders, including coordinating and providing updates to private and public sector customers and internal team(s) as necessary. The successful candidate will be involved in multiple projects and collaborate with department supervisors, managers and colleagues both in FWA and other cross functional departments. This is an exciting opportunity for an adaptable candidate to gain experience and exposure to the administrative, financial and reporting operations of the FWA department.

Requirements

Post secondary degree or equivalent work experience
3+ years of related experience in Pharmacy and/or Dental Benefits Management, Group Insurance or Health Care Operations
Highly proficient in Microsoft Access & Excel, and data warehousing applications
Experience with compiling, manipulating or validating large pieces of data
Ability to maintain electronic filing systems
Display high levels of curiosity, integrity, tact and objective judgement
Excellent organizational, planning and critical thinking skills
Excellent verbal and written communication skills, including ability to present to clients and internal stakeholders
Proven interpersonal skills and ability to work well with senior management and high-level external contacts handling sensitive or confidential information is critical
Ability to work with minimum management oversight on multiple projects with competing priorities
Ability to work a flexible schedule in high pressure environments with urgent deadlines
Proven time and resource management skills; detail oriented with strong organizational abilities

Responsibilities

Produce financial reports for clients and provide insights into trends
Responsible for provider electronic withhold entries for audit recoveries for all benefits and monitor electronic withhold to satisfy timely audit recoveries
Collect and analyze quality assurance data for public sector client meetings and internal metrics
Ensure alignment and consistency of delivery of program between all benefits
Identify emerging trends and create presentations for clients to support audit result meetings
Work with both internal and external stakeholders to address client inquiries, gather, collect information, for deliverables
Conduct monthly quality assurance review of staff time trackers
Create and maintain forecasting tools for oversight on key performance indicators and emerging trends
Oversee program training documents, SOPs, and working instructions. Ensure processes are mapped out, outlined and organized for team to utilize
Lead quality-focused remedial training sessions for team. Assist managers with maintaining training records
Identify, lead and manage special projects and program initiatives
Continuously seek opportunities to create efficiencies within processes and drive value for the program
Resolve non-routine issues escalated from other team members
Tasks involve a degree of forward planning and anticipation of needs/issues
Other duties as assigned