Dental Claims Auditor Express Scripts Canada (Mississauga)

Dental Claims Auditor – Mississauga, Permanent – Salary ($58,000–$63,000 annually )

Job Summary

The Fraud, Waste & Abuse team’s Dental Claims Auditor will enhance the value proposition for Express Scripts Canada customers by ensuring the integrity of health claims while maintaining a reliable provider network. The auditor conducts audits across Canada to confirm that providers comply with benefit plan design and professional practice regulations.

Key Responsibilities

• Perform claim verifications and conduct desk and/or on-site audits for Dental, Vision, Mental Health and other healthcare benefits.
• Communicate with providers to gather information, educate on claim submission practices, and respond to audit queries.
• Assess provider documentation for compliance with enrolment agreements, benefit plan design, and provincial regulations.
• Calculate adjustments required to correct claim transactions.
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