Job Description

Reporting to the Senior Manager of Clinical Services, Health Claims Administration and Fraud Waste and Abuse (FWA), the successful candidate will be responsible for managing the oversight and execution of our Dental FWA Program to ensure that client commitments and required service standards are delivered with timeliness and accuracy. The Dental FWA Manager will be required to meet regularly with customers to discuss the status of program results as well as identify opportunities to evolve the program, drive more value to customers and improve on service delivery. The successful incumbent will also provide direction and coaching to team members while overseeing the development and training of the department. In addition, the Dental FWA Manager will collaborate and work closely with the other managers withing the FWA department to co-lead and support the FWA Program.


The Fraud, Waste and Abuse Management team's mandate is to drive business value for customers by leading the industry in developing and using highly innovative and effective audit techniques to detect and address risk, ensuring the integrity of health and dental claims while maintaining a superior network of providers through diligent review and education.


Key areas of leadership include - Teamwork, Operational Excellence, Performance Management, Customer Service, Innovation.


This role directly contributes to building a high-performance culture within the team and the organization.

Work Location: Mississauga Head Office

Working Environment: Hybrid, 2 days/week on-site

ESSENTIAL FUNCTIONS:

Lead the Dental FWA team and oversee the development and ongoing maintenance of the Dental FWA operational policies, standards and procedures, in keeping with provincial regulations and practices, client requirements and provider agreements and manuals. Provide direction, coaching and training of department to ensure high quality service that will meet both internal and external needs Actively build and manage relationships with business partners and communicate effectively with internal colleagues, dental professionals, legal teams, regulatory associations and law enforcement authorities Ensure the standardization of practice throughout the Dental FWA team and ensures that systems, procedures and personnel are available to efficiently provide FWA services to meet our customer service level agreements and department objectives Support the design and building phase of high complexity business applications and oversees the implementation to ensure quality systems produce and maintain the desired results Evaluate products against business specifications to determine the optimum solution for the organization and our client base Responsible for ensuring client commitments are met, to present audit findings and recommendations to internal and external customers, and to ensure proper workflow and process management Schedule and track all day-to-day audit activities/services of the team and monitors audit findings to ensure effective resolution Actively manage the team to ensure effective resource allocation and consistent financial performance against budgets Oversees the production of departmental reports as required by the senior leadership team and subsequent distribution to relevant personnel and clients Develops the annual audit plan and department budget and oversees the billing of Task Authorizations to ensure accurate capture and forecasting of revenues Identifies key initiatives to improve processes, quality and efficiencies Educates others in the organization about claims practices and the ability to identify opportunities for improvement and provides leadership in development of new ideas

QUALIFICATIONS:

Diploma in a relevant field from an accredited institution 5+ years of experience in dental office settings Knowledge of provincial and federal regulations and legislation Experience in group benefits, including dental; clinical background and dental software familiarity an asset Governance, regulatory, and audit experience; accreditation in audit an asset Proven managerial ability with strong people management and talent development skills Demonstrated change management, cross-functional collaboration, and interpersonal strengths Skilled in prioritization, time/resource management, and working in fast-paced environments Strong focus on quality, accuracy, customer service, and professional presentation Excellent oral and written communication skills; bilingualism (French/English) a strong asset Proficient in Microsoft Office (Word, Excel, PowerPoint)

NOTE: Internal candidates should apply before October 20, 2025.

Express Scripts Canada is a Cigna company

Express Scripts Canada is a subsidiary of Express Scripts, a Cigna company. Cigna Corporation (NYSE: CI) is a global health service company dedicated to improving the health, wellbeing and peace of mind of those we serve. Cigna offers an integrated suite of health services through Cigna, Express Scripts, and our affiliates including medical, dental, behavioural health, pharmacy, vision, supplemental benefits, and other related products.

About Express Scripts Canada

Express Scripts Canada is a leading health benefits manager and has been recognized as one of the most innovative. Our clients include Canada's leading insurers, third party administrators and governments. We work with these clients to develop industry-leading solutions to deliver superior healthcare in a cost-controlled environment. We provide Active Pharmacy(TM) services to more than 7 million Canadian patients and adjudicate more than 100 million pharmacy, dental, and extended health claims annually. Through our proprietary consumer intelligence, clinical expertise, and patients-first approach, we promote better health decisions for plan members, while managing and reducing drug benefit costs for plan sponsors.


It will be a condition of employment that the successful candidate obtains an Enhanced Reliability Clearance from the Federal Government. The candidate will be required to provide supporting documentation to receive clearance if required.


We offer a competitive salary and benefits package, along with a positive work environment built on solid corporate values, integrity, mutual respect, collaboration, passion, service and alignment.


We are an equal opportunity employer that promotes a diverse, inclusive and accessible workplace. By embracing diversity, we build a more effective organization that empowers our employees to be the best that they can be.


We are committed to creating a working environment that is barrier-free and we are prepared to provide accommodation for people with disabilities.


If you require accommodation in completing the online application process, please email: eschr2@express-scripts.com Do not email eschr2@express-scripts.com for an update on your application or to provide your resume as you will not receive a response.