Telus

Pharmacy Claims Fraud Analyst - TELUS Health

Ongoing
Competitive
Mississauga, Ontario
Early Career

Description

Join our team

The Pharmacy Audit team of TELUS Health is seeking a Pharmacy Claims Fraud Analyst to join a fast paced and high performing team to help implement, support, maintain and grow an expanding set of responsibilities around our Pharmacy Audit protocols. The Pharmacy Audit teams serves the fundamental roles of ensuring drug claims are processed in compliance with regulating legislature and TELUS policies, educating pharmacy on best practices and addressing the dynamic risk in the pharmacy landscape.

Here's the impact you'll make and what we'll accomplish together

The Pharmacy Claims Fraud Analyst will be pivotal in identifying, monitoring the pharmacy landscape to continuously grow the Pharmacy Audit team as well as supporting its existing functions.

Here's how
  • Conduct a wide variety of claims analysis activities via data analytics based on proprietary criteria for the purpose of identification of risk claims for audit
  • Perform claims analysis and examine claims data to identify relationships, patterns and trends
  • Drive evolution of the audit program, offering recommendations to mitigate areas of risk based on results and analysis
  • Create analysis structure to ensure consistent reproducible results
  • Create efficiencies by continually examining and improving on process and procedures
  • Develop reporting and documentation standards for process control and key performance indicator (KPI) measurements
  • Review pharmacy claims submissions and prescription documentation to confirm appropriateness of claims
  • Support Pharmacy Audit team in preparing reports and by being subject matter expert (SME) on workflow applications

Qualifications

You're the missing piece of the puzzle
  • Strong analytical skills: Analyze claim information to identify risk areas
  • Knowledge of Microsoft (MS) Office especially in Outlook, with proficiency in Excel
  • Understanding of pharmacy practice environment and pharmacy claim adjudication
  • Excellent problem solving, analytical ability to synthesize information to provide recommendations with supporting rationale
  • Demonstrated analytic strength related to pharmacy/healthcare claims in support of fraud
  • Self-directed and fast learner
  • Ability to document business process or technical requirements documents
  • Ability to execute analysis activities with minimal supervision
  • Ability to prioritize workload and adapt to changing and competing priorities
  • Certified Fraud Examiner (CFE) and/or Accredited Healthcare Fraud Investigator (AHFI) designation, or Business Analysis (BA) certification or working toward the designation/certification and/or similar work experience
  • 2-3 years of experience in BA, fraud investigation
  • 2-3 years of claims adjudication business knowledge, with emphasis on problem solving
Great-to-haves
  • Knowledge of Structured Query Language (SQL) programming language
  • Registered Pharmacy Technician designation
  • 2+ years of pharmacy practice experience working in a dispensary setting
Who is TELUS?
We're a high-performing team of individuals who collectively make TELUS one of the leading telecommunications companies in Canada. Our competitive consumer offerings include wireline, wireless, internet and Optik TV™. We also deliver a compelling range of products and services for small, medium and large businesses; and have carved out a leadership position in the health, energy, finance and public sector markets with innovative industry specific solutions.
Everyone belongs at TELUS. It doesn't matter who you are, what you do or how you do it, at TELUS, your unique contribution and talents will be valued and respected. Because the more diverse perspectives we have the more likely we are to crack the code on what our customers want and our communities need.
Do you share our passion?
At TELUS, you create future friendly ® possibilities.
At TELUS, we are committed to diversity and equitable access to employment opportunities based on ability.
How to Apply