WHY THIS ROLE MATTERS:
To 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.
A component of this role includes supporting our consulting team as a technical resource. Conducting technical reviews, insights, and recommendations for the Prescription Drug portion of our clients Group Benefits plans. Keeping up with key industry trends, new products, and processes is highly valued.
WHAT YOU’LL BE RESPONSIBLE FOR :
•Conduct high quality, detailed, Drug claim audits; evaluate adjudication processes, error rate, test plan eligibility and adherence to the insurance contracts
•Review, interpret, and summarize plan designs from insurance contracts
•Analyze drug claim data, and effectively detect and evaluate patterns, trends and anomalies
•Identify opportunities, solutions, and recommendations to improve claims administrative processes with a focus on cost savings and risk management
•Prepare written reports; technical writing outlining observations and findings of claim audits
•Participate in the preparation and presentation of audit insights, findings, and recommendations:
•to current or prospective clients; and
•to generate new business opportunities
WHAT YOU BRING TO THE ROLE:
•Demonstrated knowledge and experience of Group Benefits Prescription Drug plans, with experience in retail or hospital pharmacy, pharmacy operations, drug claim billing expertise, or insurance industry
•Five to ten years of experience in processing practices of drug claims for Group Benefit plans at a TPA, PBM and/or insurance company, and claims processing in a pharmacy setting
•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, Prescription Drug plan design, Drug Utilization Reviews, Drug pricing and fee structure, Brand and generic drugs, Narcotic controls.
•Strong communicator and presenter, able to manage multiple priorities in a fast-paced, fluctuating environment with strong written and verbal skills.
•Analytical and tech-proficient, with strong research, problem-solving, and decision-making skills, and proficiency in Word, Excel, and Outlook.
•
Assets
•Recent retail, commercial, or hospital pharmacy adjudication/processing experience is strongly preferred
•Experience in adjudicating Extended Health and prescription Drug claims at an insurer or TPA or PBM
•Experience with Pharmacy Benefits Management, drug plan design, or drug reimbursement models
•Experience in Group Benefits risk management, including fraud detection and prevention strategies
WHAT WE OFFER:
•Health and Dental Benefits
•RRSP Match Program
•Hybrid Work Environment
•Paid Vacation Time
•Educational Reimbursement
•Expense Reimbursement
This is for an existing position.
Navacord DOES NOT utilize artificial intelligence in the screening, assessment, or selection of applicants for this position.
Navacord is actively committed to support diversity, equity, and inclusion. We serve and recognize and respect human differences and similarities. We value the diversity of people and actively encourage women, indigenous peoples, members of visible minorities, people with disabilities, and lesbian, gay, bisexual, transgender, and queer (LGBTQ2+) persons to apply. We are committed to providing accommodation upon request for applicants and employees with disabilities. If you require accommodation, we will work with you to meet your needs.
Prescription Drug Benefit Specialist • Greater Toronto Area, Canada
Kickstart Your Career in Life Insurance – Work From Home with AO!.Ready to make a difference while building a rewarding career in life insurance?.Join AO, the largest distribution network for Globe... Voir plus
Builds strong relationships with plan providers, ensuring the successful transmission/receipt of vendor interface files and necessary correction action for records with errors.As the primary point ... Voir plus
Blake, Cassels & Graydon LLP (Blakes), one of Canada’s largest and most successful law firms, is seeking a Total Rewards Specialist, Compensation to join the Human Resources team in Toronto.Reporti... Voir plus
Join HMG as a Remote Sales Enrollment Specialist and enjoy the flexibility of remote work.Serve clients by providing crucial advice and protection for families.This full-time role includes meeting ... Voir plus
Enhance health outcomes as a CNS Pharmaceutical Sales Specialist in Ontario.Engage customers and leverage your expertise in sales and relationship management.This position seeks an individual who c... Voir plus
Lead group benefit clients for a consulting firm, focusing on satisfaction and profitability.Requires 10+ years of experience in managing benefit plans and revenue generation. Voir plus
Step into the role of Benefits Producer, where your expertise in consultative sales will enhance client relationships and drive significant revenue growth.Focus on employee benefits and create impa... Voir plus
Elevate your career as a Benefits Producer, where your ability to nurture relationships and drive business growth will directly impact clients.Leverage your expertise to advise organizations on opt... Voir plus
Monday to Friday - standard business hours.A proudly Canadian company, Sentrex Health Solutions is a fully integrated specialty distributor and patient support provider for pharmaceutical manufactu... Voir plus
A premium wellness brand in Canada seeks a Sales Development Representative (SDR) who is results-driven and people-oriented.This fully remote role involves building rapport with potential clients, ... Voir plus
A leading recruitment agency in Canada is seeking a motivated Recruitment Consultant to join their team.This role involves managing the recruitment cycle, building a strong candidate network, and u... Voir plus
Are you ready to join an exceptional team that offers comprehensive training, benefits, and flexible working hours?.Our ideal candidate embodies qualities such as adaptability, trainability, and a ... Voir plus
Provides education and support to healthcare professionals on incontinence and skin care products.Requires clinical experience and industry knowledge. Voir plus
The Director, Corporate Accounts plays a critical role in building and sustaining long‑term partnerships with assigned specialty pharmacies.This position is responsible for driving sales performanc... Voir plus
A service-oriented company is seeking a Work-From-Home Sales Representative to educate clients about their benefits through unions and associations.This remote role requires excellent communication... Voir plus
Medical Specialist | $180/hr Remote | Mercor.Position: Medical and Health Services Manager.Commitment: 10-40 hours/week, flexible and asynchronous.Duration: Project-based (3-4 weeks initially, pote... Voir plus
This range is provided by STRIVE Recruitment Inc.Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.Our client, a respected and growing insurance o... Voir plus
With 300 employees across Canada, ivari is a company that’s making a difference in the world of life insurance.How? By finding and hiring employees who are passionate about helping people protect t... Voir plus
About the job Remote Benefits Specialist.AIL is a leading insurance and supplemental benefits provider.The company provides its clients with value and unbeatable customer service with complete tran... Voir plus
Shape employee benefits at BP Consulting as a Client-Focused Group Benefits Service Specialist.This role combines operational support with strong analytical capabilities within a consulting environ... Voir plus
){kind=logo}
