The role of the Business Integrity team is to enhance 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. The Senior Data Analyst will be responsible in supporting the requirements specific to reviewing and reporting on the department results, managing risk criteria, data mining, analyze trending patterns, developing baselines across all benefits for the purpose of making recommendations to the business and reporting in areas of potential fraud, waste and abuse. This role will also support the development of new processes and documentation relating to criteria management. These new processes will also include operational dashboards that will provide the oversight of service standards and other metrics that will assist the Business Integrity team to deliver quality services on time to the client.
Analyze and identify business trends and anomalies in all data outputs (Pharmacy, Dental and EHC) and is responsible for validating quality and accuracy of the data, summarizing findings and making recommendations to business stakeholders with focus on streamlining processes, improving business decisions and automation.
Work collaboratively with business stakeholders and data analysts to assess potential risks and review, modify and help develop audit queries, tools and reports
Help develop and maintain operational dashboards such as KPI’s for oversight on department’s performance.
Continuously seek opportunities to automate processes and create efficiencies within the department.
Manipulate and combine a variety of data sources using Python/SQL to create analytical solutions to business problems
Create report outputs, visualizations and slide decks that reflect the objectives, needs and analytical knowledge of internal and external stakeholders
Establish and maintain documentation of all methodologies and processes for stakeholders to understand the steps of the process and duplicate the process if necessary. Provide training/ knowledge transfer to technical and non-technical audiences.
Construct workflow charts and diagrams and related documentation to support new processes.
Work with confidential data in accordance to company and regulatory guidelines
Support ad hoc analysis requests as required from cross functional teams.
Monitor project process by tracking activity and providing progress updates.
Is a key participant in strategic thinking for the progression of the department (using available data) and is able to assist with implementing industry initiatives and changes to landscape.
Bachelor’s degree or equivalent work experience
5+ years relevant work experience in reporting and analytics
Experience working in health claims and/or audit
Advanced skills in MS Excel skills (create, edit, and run Excel based macros, work with advanced formulas, and pivot tables) and PowerPoint.
Strong access database skills to aid with data inquires and compiling.
Proven knowledge with data analytic querying tools such as ACL, SQL and VBA coding
Knowledge of Python and experience with OBIEE is considered an asset.
Knowledge of audit an asset, data mining/analytic capabilities, process mapping, process documentation, creation of operational dashboards to display metrics in a visually appealing way
Strong interpersonal skills, written and oral communication skills, negotiating skills, creative and innovative thinking
Ability to effectively communicate complex analytical solutions to non-technical audiences
Work in high pressure environments with urgent deadlines
High levels of critical thinking, initiative, self-management, attention to detail and prioritization skills
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.
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