1 day old

Pharmacy Claims Fraud Analyst - TELUS Health

Telus
Mississauga, ON
  • Job Code
    858814
Pharmacy Claims Fraud Analyst - TELUS Health-HEA03844-18
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
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

Primary Location:CA-ON-Mississauga

Schedule:Full-time

Categories

Posted: 2019-01-17 Expires: 2019-02-16

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Pharmacy Claims Fraud Analyst - TELUS Health

Telus
Mississauga, ON

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