Dental Claims Auditor Express Scripts

Dental Claims Auditor – Mississauga, Permanent – Salary ($58,000–$63,000 annually )

The Fraud, Waste & Abuse team’s Dental Claims Auditor will enhance the value proposition for Express Scripts Canada customers by ensuring the integrity of health claims while maintaining a reliable provider network. The auditor conducts audits across Canada to confirm that providers comply with benefit plan design and professional practice regulations.

• Perform claim verifications and conduct desk and/or on-site audits for Dental, Vision, Mental Health and other healthcare benefits.
• Communicate with providers to gather information, educate on claim submission practices, and respond to audit queries.
• Assess provider documentation for compliance with enrolment agreements, benefit plan design, and provincial regulations.
• Calculate adjustments required to correct claim transactions.
• Prepare, coordinate, and travel to conduct on-site audits and complete post‑audit activities.
• Compile and produce detailed, unbiased audit reports.
• Perform self‑ and peer‑review to ensure accuracy and quality of claim reviews.
• Track audit activity and summarize results for monthly departmental statistics presented to customers.
• Identify trends from claim reviews and recommend risk‑criteria changes or audit candidates.
• Recommend incremental ideas to enhance risk prevention and management.
• Respond to internal and external customer questions professionally and timely.
• Perform any other duties as assigned.

• Graduate of a post‑secondary dental program (dental assistant or dental hygienist) with a valid license.
• 2–5 years of recent experience in a dental office environment with knowledge of dental software and fee codes.
• Valid driver’s license and ability to travel throughout Canada (20–30% of time).
• In‑depth knowledge of dental advantages, reimbursement and dental regulations.
• Previous audit or investigative experience is an asset.
• Ability to manage confidential information.
• Strong time‑management, organizational, and critical‑thinking skills.
• Self‑driven, curious, capable of independent work with minimal supervision.
• Solid interpersonal skills; team player with cross‑functional collaboration abilities.
• Flexible, resourceful, and embraces change.
• Ability to manage high‑priority tasks in a fast‑paced environment.
• Effective research and communication of findings.
• Passion for development and continuous learning.
• Excellent verbal and written communication skills.
• Proficiency in MS Office (Excel, Word, Outlook).
• Bilingual in French & English is an asset.
• LOMA or HIAA training is an asset.

• Competitive compensation, benefits and pension plan.
• Career development and advancement opportunities.
• A culture that celebrates innovation and collaboration.
• Flexible work options and wellness programs.

All offers of employment are conditional upon successful completion of reference checks and background verification in accordance with company policy.

Obtaining and maintaining a federal government security clearance (Enhanced Reliability Clearance) is a condition of employment for this position. Candidates must meet all eligibility criteria and consent to the required security screening.

Express Scripts Canada is an equal‑opportunity employer that promotes a diverse, inclusive and accessible workplace. We are committed to creating a barrier‑free environment and providing accommodation for people with disabilities.