Bilingual Dental Consultant - Part-time - Express Scripts Canada

The Cigna Group; Mississauga; Hybrid; CAD 60,000 - 80,000; Part time

Job summary

A healthcare company is looking for a Medical Claims Review Senior Advisor in Mississauga. This role involves reviewing provider claims for accuracy and performing on-site audits. Candidates should have at least 5 years of dental office experience and be bilingual in French and English. The position is part-time and requires strong analytical skills. Travel across Canada (up to 25%) is expected.

Qualifications

• Minimum of 5 years of recent dental office experience.
• Current registration with a provincial college.
• Ability to manage confidential information.
• Strong focus on quality and accuracy.
• Detail-oriented with proven communication skills.
• Demonstrates integrity in all aspects of work.
• Excellent time management and organizational skills.
• Knowledge of Microsoft Office software.
• Bilingualism (French & English) is required.

Responsibilities

• Review provider claims reports to identify inconsistencies.
• Perform on-site audits at the provider's location in Canada.
• Summarize findings from clinical notes and lab bills.
• Ensure quality and accuracy of audit reports.
• Provide clinical opinion to support audit specialists.
• Participate in peer reviews with external clients.
• Consult with stakeholders regarding audit activities.
• Continuously review claims verification risk criteria.

Skills

Strong focus on quality and accuracy

Detail-oriented

High-level oral and written communication skills

Excellent time management

Bilingualism (French & English)

Education

Current registration with a provincial college

5+ years of experience in a dental office

Tools

Microsoft Office (Word, Excel, PowerPoint)

Job description

Medical Claims Review Senior Advisor, which is a Band 4 Senior Contributor Career Track Role.

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!

Our people make all the difference in our success.

NOTE: This position includes travelling (25%) across Canada.

This is a 12 months contract with a strong possibility of extension.

Key Responsibilities:

• Review provider claims reports to identify abnormal or inconsistent claims submissions

• Perform on-site audits at the provider’s location in Canada

• Review & summarize findings from provider chart/clinical notes, radiographs, lab bills, etc.

• Review audit reports for quality, accuracy, and proper audit application

• Provide clinical opinion to support audit specialists

• Participate as required in peer reviews with external clients

• Consult with internal and external stakeholders regarding audit activities

• Continuously review and provide recommendations regarding claims verification risk criteria

Qualifications:

• Minimum of 5 years of recent and demonstrated experience within a dental office environment

• Current registration with a provincial college

• Ability to manage confidential information

• Strong focus on quality and accuracy

• Detail-oriented with proven high-level oral and written communication skills

• Demonstrates and applies integrity in all aspects of work

• Excellent time management and organizational skills

• Knowledge of Microsoft Office software (Word, Excel and PowerPoint)

• Bilingualism (French & English) is required.

Express Scripts Canada has an exciting opportunity for a dentist who is looking to expand their career to use their analytical and investigative skills along with their practice and knowledge of benefit coverage. This part-time role in the Business Integrity team enhances the Express Scripts Canada (ESC) value proposition for customers to ensure the integrity of health claims while maintaining a network of providers through diligent review and education.

Responsabilités principales

• Réviser les rapports sur les demandes de règlement afin de déceler les demandes de règlement qui présentent des anomalies ou des incohérences.

• Effectuer des audits sur place, dans des cabinets dentaires au Canada.

• Examiner les notes consignées aux dossiers des patients, les radiographies, les factures de laboratoire et résumer ses constatations.

• Examiner les rapports d’audit afin d’en assurer la qualité et l’exactitude et de confirmer que le processus d’audit a bien été suivi.

• Donner une opinion professionnelle afin d’apporter du soutien aux spécialistes des audits.

• Participer à des révisions par les pairs, au besoin, avec les clients à l’externe.

• Discuter des activités d’audit avec les intervenants à l’interne et à l’externe.

• Réviser les critères de risque relatifs à la vérification des demandes de règlement et faire des recommandations.

Qualification

• Posséder cinq années d’expérience récente dans un cabinet dentaire.

• Être membre d’une association dentaire provinciale.

• Être en mesure de gérer des renseignements confidentiels.

• Mettre l’accent sur la qualité et l’exactitude.

• Être minutieux et posséder d’excellentes habiletés de communication à l’oral comme à l’écrit.

• Faire preuve d’intégrité dans tous les aspects de son travail.

• Posséder d’excellentes aptitudes en gestion du temps et avoir un bon sens de l’organisation.

• Connaître les logiciels de la suite Microsoft Office (Word, Excel et PowerPoint)

• Être bilingue (français et anglais), à l’oral comme à l’écrit.

Note: Internal posting will be closed on October 13, 2025

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.