Pharmacy Drug Claims Auditor II

Job Responsibility: Location: Toronto, ON, CA, M5J 2V5 Halifax, NS, CA Calgary, AB, CA Vancouver, BC, CA Ottawa, ON, CA Req ID: 48619 Jobs by Category: Health Job Function: Health Solutions Status: Full Time Schedule: Regular

Description

About Us

At TELUS Health, we are at the forefront of innovative healthcare solutions in Canada. As a leader in integrated drug, dental, and extended health claims management, we are seeking a detail-oriented Pharmacy Drug Claims Auditor II to join our dynamic team and contribute to the integrity of our pharmacy claims processes.

We are looking for a Pharmacy Drug Claims Auditor II who combines in-depth knowledge of pharmacy operations with sharp analytical skills. This role is ideal for someone with a Pharmacy Technician background who is passionate about diving deep into the complexities of drug claims, identifying discrepancies, and driving process improvements.

What You will Do

• Conduct comprehensive audits of pharmacy claims, examining and interpreting pharmacy records against submitted claim data for potential discrepancies
• Validate claim documentation and systems data to ensure accurate processing in accordance with contractual and regulatory obligations
• Analyze trends in pharmacy claims data to identify patterns, potential fraud, and areas for process improvement
• Collaborate with pharmacies, insurance providers, and internal teams to resolve complex claim issues
• Develop and implement strategies to enhance the efficiency and accuracy of the claims auditing process
• Provide expert guidance on pharmacy-related matters to other departments within TELUS Health
• Stay current with pharmacy regulations, drug formularies, and industry best practices

Qualifications

What You Bring

• Pharmacy Technician certification with 3+ years of experience in pharmacy operations or claims processing
• In-depth understanding of pharmacy drug claims processes, including billing procedures and common discrepancies
• Strong analytical and problem-solving skills, with the ability to think critically about complex claims issues
• Excellent attention to detail and the ability to manage large volumes of data accurately
• Proficiency in data analysis tools and pharmacy management software
• Outstanding communication skills, both written and verbal, with the ability to explain technical findings to various audiences
• Demonstrated ability to work independently and as part of a team
• Commitment to continuous learning and staying updated on pharmacy industry trends and regulations
• Strong analytical skills and attention to detail
• Self-motivated and results-oriented, with a strong drive to achieve program targets
• Proficiency in Microsoft Office Suite and Google Suite, including Excel, PowerPoint, Google drive, Google sheets, required
• Excellent communication and interpersonal skills
• Ability to work independently and collaboratively in a fast-paced, dynamic environment.
• Ability to travel within Canada as needed by the business, required
• Hold a valid driver's license, required
• Bilingual, an asset

Why TELUS Health?

• Opportunity to apply your pharmacy expertise in a dynamic, technology-driven environment
• Flexible work arrangements through our TELUS Work Styles program
• Competitive salary and comprehensive benefits package
• Continuous learning and development opportunities in healthcare technology and claims management
• Collaborative work environment that values innovation and process improvement

If you are ready to leverage your pharmacy background and analytical skills to make a significant impact on the integrity of drug claims processing, we want to hear from you. Join us in our mission to improve healthcare outcomes for Canadians through innovative claims management solutions.

By applying to this role, you understand and agree that your information will be shared with the TELUS Group of Companies' Talent Acquisition team(s) and/or any leader(s) who will be part of the selection process.

Actual total compensation will be determined based on factors such as knowledge, skills, performance, experience and location. Additionally, TELUS offers rewarding benefits, which may vary per job function, such as:

• Comprehensive total rewards package highlighting competitive salary and bonus structures, minimum 3 weeks of vacation, and flexible benefits plan to meet the needs of you and your family
• Flexibility to work in-office, virtually or a combination of both
• Generous company matched pension and share purchase programs
• Opportunity to give back to communities in which we work, live and serve
• Career growth and learning & development opportunities to develop your skills
• And much more …

Please note that the compensation shown in the job posting may be subject to change in 2025.

A bit about us

We're a people-focused, customer-first, purpose-driven team who works together every day to innovate and do good. We improve lives through our technology solutions and foster a culture of innovation that empowers team members to solve complex problems and create remarkable human outcomes in a digital world.

You'll find our engaging, high-performance culture personally fulfilling, professionally challenging, and financially rewarding. We're committed to diversity and equitable access to employment opportunities based on ability. Your unique contributions and talents will be valued and respected here. When you join our team, you're helping us make the future friendly.

TELUS Health is an IT leader in Canada that focuses on the health sector. Our mission is to improve the way information is being used along the continuum of care to better the health of citizens in Canada and in selected countries.

Disclaimer: In accordance with the TELUS Health Solutions Data Center Security Policy, as a condition of employment, all team members whose job functions require they work at a Data Center and/or have access to detailed knowledge of technology related to client service delivery, are subject to a Personnel Security Screening conducted through the Government of Canada.

The health and safety of our team, customers and communities is paramount to TELUS. Accordingly, we require anyone joining our TELUS Health Care Centres to be fully vaccinated for COVID-19.

Note for Quebec candidates: if knowledge of English is required for this position, it is because the team member will be asked, on a regular basis, to interact in English with external or internal parties or to use English applications or software as part of their tasks.

By applying to this role, you understand and agree that your information will be shared with the TELUS Group of Companies' Talent Acquisition team(s) and/or any leader(s) who will be part of the selection process.