Claims Supervisor - Express Scripts Canada

Claims Supervisor - Express Scripts Canada

Claims Supervisor - Express Scripts Canada

Apply remote type Hybrid locations Toronto, ON time type Full time posted on Posted 3 Days Ago job requisition id 25001610

Health Claims Administration processes manual claims for vision care, mental health counselling, dental and pharmacy benefits, and provides accurate claims adjudication within service delivery standards. In addition, this department is responsible for investigating and responding to inquiries, and updating process documents to support the claim verification function. Health Claims Administration is also responsible for updating the dental and extended healthcare plan set up according to customer request and design.

Express Scripts Canada (ESC) seeks to hire a Claims Supervisor reporting to the Manager, Health Claims Administration. As the Claims Supervisor you will provide support to internal and external customers. The Supervisor provides leadership in the following areas: Teamwork, Operational excellence, Performance Management, Change Management, Customer Service and Innovation. This job should directly contribute to building a higher performance culture and living the values of Express Scripts Canada.

ESSENTIAL FUNCTIONS:

• Supervise, lead and develop a team of Claims Processors through workload management, regular performance reviews, day-to-day coaching
• Review the workflow within the unit on a daily basis
• Work with Manager to identify productivity and process improvements
• Escalate issues to Manager as required – identify risks and present solutions for optimizing results
• Ensure claims turnaround time and productivity objectives are met based on service level standards
• Ensure that team members are efficiently trained and provided with the appropriate tools to perform their jobs
• Work with Quality Assurance Analyst to address opportunities with quality
• Motivate, supervise and identify coaching/training opportunities for staff. Provide ongoing feedback on a bi-weekly basis and conduct goal check in’s with staff
• Maintain various records and submit daily, weekly or monthly reports as required
• Responsible for monitoring all filing on/off site (Iron Mountain Storage)
• To track monthly Key Performance Indicators (KPI’s) statistics on turnaround times (TAT’s)
• Support all internal Express Scripts Canada departments which rely on the daily operations of Claims Services
• Manage the day-to-day claims processing operation according to established performance standards and documented NIHB policies and procedures for both French and English vision care, mental health counselling, dental, medical supplies & equipment (MS&E) and pharmacy claims processing services
• Track key metrics for reporting, communication, forecasting, staffing
• Culture: consistent practices, ESC values, staff morale
• Contributions of this role will assist Express Scripts Canada in meeting Claims Processing SLA’s, maintaining customer satisfaction, optimizing resource utilization and achieving operational excellence

QUALIFICATIONS:

• Bachelor’s degree or related job experience
• A minimum of 3-5 years experience in group claims adjudication with a focus on health and dental claims with related leadership experience
• Proven analytical and decision-making skills
• Knowledge of group benefits and claim administration
• Strong focus on customer service is required
• Ability to identify opportunities for improvement and development of new ideas
• Ability to coach/train, give and receive feedback in a constructive manner
• Excellent organization and planning skills
• Strong time management skills and ability to work under tight deadlines
• Strong presentation skills
• Proven people management/leadership skills – ability to develop talent
• Ability to build strong diverse teams
• Strong analytical skills
• Ability to think strategically
• Ability to adapt and prioritize workload
• Working knowledge of Microsoft Office Suite of tools (Word, Excel, Outlook)
• Performance management skills
• Strong communication skills both verbal and written
• Bilingualism (French/English) is an asset

*Internal application deadline: March 12, 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 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.