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Orion Audit Ltd.: Drug Claim Auditor

Orion Audit Ltd.

This is a Full-time position in St Jacobs, ON posted September 17, 2020.

Drug Claim Auditor *Preference is given to pharmacy assistants or technicians*Orion Audit Limited has been conducting Drug, Extended Health, Dental and Disability Group benefits claims audits since 2005.

We have quickly emerged as the industry leader and have a reputation for bringing strong governance and accountability to benefit plans across Canada.We are seeking innovative and energetic individuals with impressive experience and a proven track record to join us and contribute to our standard of excellence in the area of prescription drug insurance claim audits.

The complexity of auditing prescription drug claims requires experience in pharmacy billing.

A person with a keen eye for detail, and investigative mind set, and the ability to work collaboratively in a challenging environment will find success in this role.

Main working location is St.

Jacobs, Ontario, with some travel to Vaughan.Job ScopeTo conduct high-quality and detailed prescription drug claim audits on behalf of our clients.

This includes analyzing prescription drug claims data, detecting and evaluating patterns, trends and anomalies, and turning them into meaningful insights and recommendations for our clients through formal written reports and presentations.This role requires a dedicated, detail-oriented individual, that can work both collaboratively in a team environment and be self-motivated to work independently as needed.

If you are looking for an opportunity where you are proud of the work you do, eager to learn and go home at the end of the day knowing you made a difference for our clients, Orion will be a good fit for you!ResponsibilitiesConduct high quality, detailed, drug claim audits; evaluate adjudication processes, error rate, test plan eligibility and adherence to the insurance contractSummarize plan designs from insurance contractsAnalyze drug claim data and effectively detect and evaluate patterns, trends and anomaliesIdentify opportunities and solutions to make recommendations to improve claims administrative processes with a focus on cost savings and risk managementPrepare written reports; technical writing outlining observations and findings of claims auditParticipate in the preparation and presentation:-of audit findings to clients-to generate new business opportunitiesRequirementsDemonstrated knowledge and experience of Group Benefits health/drug plans with experience in retail or hospital pharmacy, pharmacy operations, the pharmacy industry or insuranceFive to ten years of experience in processing practices of drug claims for Group Benefit plans at a TPAand/or insurance company and in a pharmacy settingStrong working knowledge of provincial pharmacare programs; including both private and public reimbursement models-Solid background and familiarity with:-Industry best practices-Coordination of benefits-Internal audit processes and fraud detection-Drug plan design-Drug utilization review-Drug pricing and fee structure-Drug data analysis-Brand and generic drugs-Claims validation-Narcotic controlsResults oriented; ability to balance multiple prioritiesComfortable speaking/presenting information in a group settingAbility to manage fluctuating and unpredictable workloadStrong attention to detail, research, problem solving and decision-making skillsProficient in computer applications (MS Word, Excel, Outlook)Demonstrated strong written and verbal communication skillsAssets: Recent retail, commercial, or hospital pharmacy adjudication/processing experience is strongly preferredExperience in adjudicating Extended Health and Drug claimsExperience with pharmacy benefit management, drug plan design, or drug reimbursement modelsJob TypeSchedule: Full TimeDue to current COVID 19 situation, role is temporarily work from home during this timeTravel: 20% travel is across Canada and to head office in Vaughan, ONCompetitive compensation based on experience