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Pharmacy Claims Investigator - Express Scripts Canada


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The objective of the Pharmacy Audit Services team is to proactively detect and address risks in a timely manner that effectively manages the financial risk and reputation of Express Scripts Canada customers. The Investigator is responsible for conducting audits and investigation, which will help detect fraud, waste, and abuse in claim submissions and prevent future misuse. This is achieved by identifying provider, member and prescriber fraud and abuse risks using expertise, knowledge, data analytics, and critical thinking skills to take a proactive risk management approach. The investigator is responsible for conducting complex investigational audits and present findings both verbally and in writing to key internal and external stakeholders, including coordinating and providing updates to customers risk management team(s) as necessary. The investigator also serves as a lead in developing and mentoring the Auditors on the team.